| Object:Analysis the clinical data of postoperative gynecological surgery patients, to understand the current type, degree and cause of postoperative electrolyte disorders, to provide guidance for prevention and treatment of postoperative electrolyte disorders. Method:Collect and analyze clinical data of 1858 patients who undergo operations during Jan 1st to Dec 31 st in 2014 in the First Hospital of Jilin University, enumeration data and univariate analysis using Kruskal Wallis H test(K-W test), and multivariate analysis use logistic regression analysis to achieve statistical analysis. Result:1. The type of electrolyte disorders analysis: 572 out of 1858 postoperative patients have postoperative hypokalemia(30.78%): 529 mild hypokalemia, 43 moderate hypokalemia; 281 patients have low sodium(15.12%): 247 mild low sodium and 34 moderate low sodium; 1519 patients have hypocalcemia(81.76%): 1444 mild low calcium and 75 severe low calcium.2. the influence of different factors on postoperative electrolyte disorder2.1 age: 1858 cases of gynecological surgery were included in the statistics, the age distribution is between 17-78, mainly from 40 to 60 years old. the average age is 41.29 + 11.05 years old, There were differences in electrolyte disorder after operation between different age groups, the older, the easier to have postoperative electrolyte disorder, and there was a significant difference between any two groups(P < 0.0001).2.2 complications: the complications are mainly hypertension and diabetes, the incidence of postoperative electrolyte disorder in patients with complications was significantly higher than those who have no complications, the difference was statistically significant(P < 0.0001).2.3 smoking: the incidence of postoperative electrolyte disorder in smoking patients was higher than the no smoking group, the difference was statistically significant(P < 0.001);2.4Bowel preparation before surgery: the proportion of postoperative electrolyte disorders in bowel preparation group is significantly higher than those without bowel preparation group, the difference was statistically significant(P < 0.0001);2.5 mental factors: the incidence of postoperative electrolyte disorders occurred in the nervous patients is higher than that in the patients who have common mentality, The comparison was statistically significant(P < 0.001).2.6 obesity: in this survey, the incidence of postoperative electrolyte disorders has no significant effect between the two groups(obese and normal weight patients).there is not statistically significant(P > 0.05).2.7 the type of diseases: the types of gynecology diseases mainly contain endometrial benign diseases, benign diseases of uterus, fallopian tube diseases, benign ovarian diseases, pelvic floor dysfunction diseases, malignant tumor, cervical lesions and abdominal uterine endometriosis. the incidents of postoperative electrolyte disorders in different diseases occur difference significantly(P < 0.0001). Benign uterine diseases, malignant tumors and ovarian chocolate cyst is more prone to postoperative electrolyte disturbance(P < 0.0001), uterine fibroids, ectopic pregnancy and ovarian chocolate cyst operation easier to occur severe hypocalcemia.2.8 surgical procedures:mainly laparotomy, laparoscopic surgery, hysteroscopy surgery, vaginal surgery, cervical cone and so on, the statistical result shows that laparotomy and vaginal surgery are more prone to have postoperative electrolyte disorder(P < 0.0001).2.9 operation time: operation time and postoperative electrolyte disturbance were significantly correlated, the longer operation time is, the easier the postoperative electrolyte disorder occurs(P < 0.001);2.10 pain pumps: the probability of patients who use postoperative pain pumps is higher than the one who are not the users of pain pumps(P < 0.0001).2.11 anesthesia methods: there are 696 cases of hysteroscopy surgery, compared with intravenous anesthesia, general anesthesia is easier to have hypokalemia(P < 0.0001). but the incidence of low sodium has no significant effect between the two groups(intravenous anesthesia and general anesthesia).they are not statistically significant(P > 0.05).2.12 Anesthesia: intravenous anesthesia and general anesthesia patients compared to patients after general anaesthesia occurred probability of hypokalemia higher(P < 0.0001), and intravenous anesthesia patients with general anesthesia after the occurrence probability of hyponatremia correlated(P > 0.05).2.13 nausea and vomiting: patients who suffer nausea and vomiting are more prone to have electrolyte disorders(P < 0.0001).2.14 high fever: high fever is defined as the temperature > 38.5 degrees, through the statistical analysis, the probability of occurring electrolyte disorders in which postoperative patients with high fever is higher than those without high fever(P < 0.0001).2.15 oxytocin: postoperative application of oxytocin and the occurrence of hypokalemia is associated, continuous usage of oxytocin is more prone to have hypokalemia(P < 0.0001), while the incidence of low sodium is not correlated(P > 0.05).3 the related factors of gynecological postoperative electrolyte disorders3.1 Univariate analysis of influencing factorsIn the statistical results, age, complications, smoking, mental factors, bowel preparation, disease types, surgical procedures, operation time, pain pumps, high fever, nausea and vomiting are the main impact factors of postoperative electrolyte disorders. Uterine fibroids, ectopic pregnancy and ovarian chocolate cyst can cause severe hypocalcemia.3.2 multivariate logistic regression analysis shows that age, bowel preparation, smoking and operation time are the independent influencing factors of postoperative hyponatremia, as to the postoperative low sodium, the main influencing factors are complications, types of diseases, operation time and mental. Conclusion:1.the statistical results show that the incidence of gynecologic surgery electrolyte disorders is high, they are hypocalcemia, hypokalemia and hyponatremia.2. age, complications, smoking, mental factors, bowel preparation, disease types, surgical procedures, operation time, pain pumps, high fever, nausea and vomiting are the main affective factors of postoperative electrolyte disorders.3. Hysteroscopy is more suitable for intravenous anesthesia in endometrial disease。4.Focus on women’sperioperative management,make a reasonable choice of surgical methods and drugs after operations,shorten the operation time,we can reduce the occurrence of postoperative electrolyte disturbance。... |
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