{"title":"结直肠癌手术尿毒症患者麻醉技术及术后并发症的回顾性分析。","authors":"Xue-Jian Zheng, Zhi-Xiong Zhang, Jian Du","doi":"10.4240/wjgs.v17.i8.105970","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Patients with uremia undergoing colorectal cancer surgery face an increased risk of postoperative complications due to impaired renal function, challenges in fluid balance, and the complexities of anesthetic management. Effective anesthesia and fluid strategies are critical to reducing complications and improving outcomes. Total intravenous anesthesia (TIVA) and goal-directed fluid therapy (GDT) have been suggested to enhance perioperative stability compared with inhalational anesthesia and standard fluid therapy. However, evidence supporting their efficacy in patients with uremia remains limited.</p><p><strong>Aim: </strong>To evaluate the effects of different anesthetic techniques on postoperative complications in patients with uremia undergoing colorectal cancer surgery.</p><p><strong>Methods: </strong>This retrospective cohort study included 120 patients with stage 3-5 uremia who underwent elective colorectal cancer surgery between January 2022 and December 2024. Patients received either inhalational anesthesia or TIVA, combined with either standard fluid therapy or GDT. The primary outcome measure was the incidence of postoperative complications. Secondary outcomes included length of hospital stay, major complications, and 30-day mortality.</p><p><strong>Results: </strong>Postoperative complications occurred in 23.3% (28/120) of patients. TIVA was associated with a lower complication rate than that of inhalational anesthesia (20.0% <i>vs</i> 26.7%, <i>P</i> = 0.045). GDT resulted in significantly reduced fluid administration (2400 mL <i>vs</i> 3100 mL, <i>P</i> < 0.001) and lower complication rates (19.5% <i>vs</i> 28.2%, <i>P</i> = 0.030) compared with those of standard management. Independent risk factors for complications included age over 75 years (OR: 2.40, 95%CI: 1.60-3.60), stage 5 uremia (OR: 1.85, 95%CI: 1.20-2.85), and cumulative fluid balance exceeding 2000 mL (OR: 1.70, 95%CI: 1.10-2.65). Patients with complications had longer hospital stays (median, 15 days <i>vs</i> 11 days; <i>P</i> < 0.001) and higher rates of major complications (27.8% <i>vs</i> 13.5%; <i>P</i> = 0.003).</p><p><strong>Conclusion: </strong>In patients with uremia undergoing colorectal cancer surgery, TIVA and GDT are associated with a lower incidence of postoperative complications compared with that of inhalational anesthesia and standard fluid management. Optimizing anesthetic techniques and fluid management may improve postoperative outcomes in this high-risk population.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":"17 8","pages":"105970"},"PeriodicalIF":1.7000,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12427018/pdf/","citationCount":"0","resultStr":"{\"title\":\"Retrospective review of anesthesia techniques and postoperative complications in patients with uremia undergoing colorectal cancer surgery.\",\"authors\":\"Xue-Jian Zheng, Zhi-Xiong Zhang, Jian Du\",\"doi\":\"10.4240/wjgs.v17.i8.105970\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Patients with uremia undergoing colorectal cancer surgery face an increased risk of postoperative complications due to impaired renal function, challenges in fluid balance, and the complexities of anesthetic management. Effective anesthesia and fluid strategies are critical to reducing complications and improving outcomes. Total intravenous anesthesia (TIVA) and goal-directed fluid therapy (GDT) have been suggested to enhance perioperative stability compared with inhalational anesthesia and standard fluid therapy. However, evidence supporting their efficacy in patients with uremia remains limited.</p><p><strong>Aim: </strong>To evaluate the effects of different anesthetic techniques on postoperative complications in patients with uremia undergoing colorectal cancer surgery.</p><p><strong>Methods: </strong>This retrospective cohort study included 120 patients with stage 3-5 uremia who underwent elective colorectal cancer surgery between January 2022 and December 2024. Patients received either inhalational anesthesia or TIVA, combined with either standard fluid therapy or GDT. The primary outcome measure was the incidence of postoperative complications. Secondary outcomes included length of hospital stay, major complications, and 30-day mortality.</p><p><strong>Results: </strong>Postoperative complications occurred in 23.3% (28/120) of patients. TIVA was associated with a lower complication rate than that of inhalational anesthesia (20.0% <i>vs</i> 26.7%, <i>P</i> = 0.045). GDT resulted in significantly reduced fluid administration (2400 mL <i>vs</i> 3100 mL, <i>P</i> < 0.001) and lower complication rates (19.5% <i>vs</i> 28.2%, <i>P</i> = 0.030) compared with those of standard management. Independent risk factors for complications included age over 75 years (OR: 2.40, 95%CI: 1.60-3.60), stage 5 uremia (OR: 1.85, 95%CI: 1.20-2.85), and cumulative fluid balance exceeding 2000 mL (OR: 1.70, 95%CI: 1.10-2.65). Patients with complications had longer hospital stays (median, 15 days <i>vs</i> 11 days; <i>P</i> < 0.001) and higher rates of major complications (27.8% <i>vs</i> 13.5%; <i>P</i> = 0.003).</p><p><strong>Conclusion: </strong>In patients with uremia undergoing colorectal cancer surgery, TIVA and GDT are associated with a lower incidence of postoperative complications compared with that of inhalational anesthesia and standard fluid management. Optimizing anesthetic techniques and fluid management may improve postoperative outcomes in this high-risk population.</p>\",\"PeriodicalId\":23759,\"journal\":{\"name\":\"World Journal of Gastrointestinal Surgery\",\"volume\":\"17 8\",\"pages\":\"105970\"},\"PeriodicalIF\":1.7000,\"publicationDate\":\"2025-08-27\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12427018/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"World Journal of Gastrointestinal Surgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.4240/wjgs.v17.i8.105970\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"GASTROENTEROLOGY & HEPATOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"World Journal of Gastrointestinal Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.4240/wjgs.v17.i8.105970","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}
引用次数: 0
摘要
背景:接受结直肠癌手术的尿毒症患者由于肾功能受损、体液平衡的挑战和麻醉管理的复杂性而面临术后并发症的风险增加。有效的麻醉和输液策略对减少并发症和改善预后至关重要。与吸入麻醉和标准液体治疗相比,全静脉麻醉(TIVA)和目标定向液体治疗(GDT)被认为可以提高围手术期的稳定性。然而,支持它们对尿毒症患者有效的证据仍然有限。目的:探讨不同麻醉方式对大肠癌手术尿毒症患者术后并发症的影响。方法:这项回顾性队列研究包括120例3-5期尿毒症患者,他们在2022年1月至2024年12月期间接受了选择性结直肠癌手术。患者接受吸入麻醉或TIVA,联合标准液体疗法或GDT。主要观察指标是术后并发症的发生率。次要结局包括住院时间、主要并发症和30天死亡率。结果:术后并发症发生率为23.3%(28/120)。与吸入麻醉相比,TIVA并发症发生率较低(20.0% vs 26.7%, P = 0.045)。与标准治疗相比,GDT显著减少了液体给药量(2400 mL vs 3100 mL, P < 0.001),降低了并发症发生率(19.5% vs 28.2%, P = 0.030)。并发症的独立危险因素包括年龄超过75岁(OR: 2.40, 95%CI: 1.60-3.60)、5期尿毒症(OR: 1.85, 95%CI: 1.20-2.85)和累积体液平衡超过2000 mL (OR: 1.70, 95%CI: 1.10-2.65)。并发症患者住院时间较长(中位数为15天vs 11天;P < 0.001),主要并发症发生率较高(27.8% vs 13.5%; P = 0.003)。结论:在接受结直肠癌手术的尿毒症患者中,与吸入麻醉和标准液体管理相比,TIVA和GDT的术后并发症发生率较低。优化麻醉技术和液体管理可以改善这一高危人群的术后预后。
Retrospective review of anesthesia techniques and postoperative complications in patients with uremia undergoing colorectal cancer surgery.
Background: Patients with uremia undergoing colorectal cancer surgery face an increased risk of postoperative complications due to impaired renal function, challenges in fluid balance, and the complexities of anesthetic management. Effective anesthesia and fluid strategies are critical to reducing complications and improving outcomes. Total intravenous anesthesia (TIVA) and goal-directed fluid therapy (GDT) have been suggested to enhance perioperative stability compared with inhalational anesthesia and standard fluid therapy. However, evidence supporting their efficacy in patients with uremia remains limited.
Aim: To evaluate the effects of different anesthetic techniques on postoperative complications in patients with uremia undergoing colorectal cancer surgery.
Methods: This retrospective cohort study included 120 patients with stage 3-5 uremia who underwent elective colorectal cancer surgery between January 2022 and December 2024. Patients received either inhalational anesthesia or TIVA, combined with either standard fluid therapy or GDT. The primary outcome measure was the incidence of postoperative complications. Secondary outcomes included length of hospital stay, major complications, and 30-day mortality.
Results: Postoperative complications occurred in 23.3% (28/120) of patients. TIVA was associated with a lower complication rate than that of inhalational anesthesia (20.0% vs 26.7%, P = 0.045). GDT resulted in significantly reduced fluid administration (2400 mL vs 3100 mL, P < 0.001) and lower complication rates (19.5% vs 28.2%, P = 0.030) compared with those of standard management. Independent risk factors for complications included age over 75 years (OR: 2.40, 95%CI: 1.60-3.60), stage 5 uremia (OR: 1.85, 95%CI: 1.20-2.85), and cumulative fluid balance exceeding 2000 mL (OR: 1.70, 95%CI: 1.10-2.65). Patients with complications had longer hospital stays (median, 15 days vs 11 days; P < 0.001) and higher rates of major complications (27.8% vs 13.5%; P = 0.003).
Conclusion: In patients with uremia undergoing colorectal cancer surgery, TIVA and GDT are associated with a lower incidence of postoperative complications compared with that of inhalational anesthesia and standard fluid management. Optimizing anesthetic techniques and fluid management may improve postoperative outcomes in this high-risk population.