중환자간호학회지 (Journal of Korean Critical Care Nursing)

  • 제14권1호
  • /
  • Pages.28-39
  • /
  • 2021
  • /
  • 2005-212X(pISSN)
  • /
  • 2671-8634(eISSN)
한국중환자간호학회 (Korean Society of Critical Care Nursing)
권호 표지
DOI QR코드

DOI QR Code

척추수술환자의 장폐색 발생 관련요인

Related Factors in the Occurrence of Postoperative Ileus Following Spinal Surgery

  • 투고 : 2020.12.24
  • 심사 : 2021.01.21
  • 발행 : 2021.02.28
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

Purpose : This study investigated the occurrence of postoperative ileus and its related factors in patients after spinal surgery. Methods : After a retrospective review of data from patients who underwent spinal surgery at a single hospital located in Busan from 2012 through 2016, a total of 253 patients were included. The subjects were divided into non-ileus and ileus groups. We compared patient-, surgery-, and postoperative hematological-related factors. Results : A total of 41 (16.2%) out of 253 patients experienced postoperative ileus. Data analysis revealed significant differences between the two groups in mean age (68.44 vs 60.50 years), occupation (9.8 vs 28.8%), cardiovascular comorbidity (63.4 vs 37.7%), approach of surgery (supine/prone: 29.3/70.7 vs 12.7/87.3%), duration of anesthesia (5.86 vs 4.43 hours), narcotic use (75.6 vs 56.6%), postoperative serum hemoglobin level (3 days: 10.81 vs 11.41 g/dL), postoperative serum protein (immediately/3 days: 5.30/5.43 vs 5.62/5.68 g/dL), postoperative albumin level (3 days: 3.17 vs 3.40 g/dL), postoperative C-reactive protein level (3 days: 11.44 vs 8.36 mg/dL), postoperative bed stabilization period (3.32 vs 2.50 days), and onset of bowel movement (2.59 vs 1.94 days). In multivariate logistic regression, age and time of anesthesia were independent risk factors of postoperative ileus. Conclusion : To detect ileus after spinal surgery early, nurse education is needed with intensive screening on advanced age, surgery-related factors, and postoperative hematological indices.

키워드

참고문헌

  1. Park SR. Effects of a structured physical educations for spinal surgery patients on daily living function. Korean Journal of Women's Health. 2014;15(1): 39-55.
  2. National Health Insurance Service. Main Surgery Statistical Yearbook for 2019 [Internet]. Wonju: National Health Insurance Service; 2020 [cited 2021 January 14]. Available from: https://www.nhis.or.kr/nhis/together/wbhaec06800m01.do?mode=download&articleNo=10803657&attachNo=312917
  3. Kim JH, Lhim SC, Roh SW, Lee SJ, Ko YM, Kim YO, et al. Effects of sequential application of superficial cold and heat on pain, patient satisfaction with pain control, comfort level and subjective response after spine surgery. Journal of Korean Academy of Fundamentals Nursing. 2016;23(2):184-93. https://doi.org/10.7739/jkafn.2016.23.2.184
  4. Lee MY, Park HS, Kim JW, Yoon SJ, Moon NK, Choi JH. A descriptive study on abdominal discomfort after scoliosis corrective surgery. Journal of Korean Clinical Nursing Research. 2016;.22(3):345-51. https://doi.org/10.22650/JKCNR.2016.22.3.345
  5. Kim HJ, Cha YH. Complications and risk factors of surgery for adult spine deformity. Journal of Korean Orthopaedic Association. 2016;51(1):40-7. https://doi.org/10.4055/jkoa.2016.51.1.40
  6. Lee TH, Lee JS, Hong SJ, Jang JY, Chen SR, Byun DW. et al. Risk factors for postoperative ileus following orthopedic surgery: the role of chronic constipation. Journal of Neurogastroenterology and Motility. 2015;21(1):121-5.https://doi.org/10.5056/jnm14077
  7. Bragg D, Ahmed ME, Emmanouil P, Charies A, Maxwell-Armstrong CA, Lobo DN. Postoperative ileus: recent developments in pathophysiology and management. Clinical Nutrition. 2015;34(3):347-76. https://doi.org/10.1016/j.clnu.2015.01.016
  8. Park HS, Park JM, Suh JP, Chang JH, Nam KW, You CR, et al. A case of ischemic colitis complicated by pneumatosis intestinalis and colonic stricture. Korean Journal of Medicine. 2008;75(3S);S745-50.
  9. Lee HS, Shim HJ, Lee HS, Lee JG, Kim KS. The safety of early enteral feeding after emergency gastrointestinal surgery. Korean Journal of Gastroenterology. 2011;58(6):318-22. https://doi.org/10.4166/kjg.2011.58.6.318
  10. Millan M, Biondo S, Fraccalvieri D, Frago R, Golda T, Kereisler E. Risk factors for prolonged postoperative ileus after colorectal cancer surgery. World Journal of Surgery. 2012;36(1):179-85. https://doi.org/10.1007/s00268-011-1339-5
  11. Wright AK, Selva DL, Nkrumah L, Yanamadala V, Leveque JC, Sethi RK. Postoperative ileus: old and new observations on prevention and treatment in adult spinal deformity surgery. World Neurosurgery. 2019;132:e618-22. https://doi.org/10.1016/j.wneu.2019.08.062
  12. Behm B, Stollman N. Postoperaive ileus: etiologies and interventions. Clinical Gastroenteology and Hepatology. 2003;1(2):71-80. https://doi.org/10.1053/cgh.2003.50012
  13. Venara, A, Neunlist M, Slim K, Barbieux J, Colas PA, Hamy A. et al. Postoperative ileus: pathophysiology, incidence and prevention. Journal of Visceral Surgery. 2016;153(6), 439-46. https://doi.org/10.1016/j.jviscsurg.2016.08.010
  14. Fineberg SJ, Nandyala SV, Kurd MF, Marquez-Lara A, Noureldin M, Patel AA, et al. Incidence and risk factors for postoperative ileus following anterior, posterior, and circumferential lumbar fusion. The Spine Journal. 2014;14(8):1680-5. https://doi.org/10.1016/j.spinee.2013.10.015
  15. Lee SJ, Hwang JK, Choi KW. Small-bowel obstruction in patients with a previous history of abdominal surgery due to cancer. Annals of Surgical Treatment and Research. 2000;58(5):656-60.
  16. Vather R, Josephson R, Jaung R, Robertson JP, Bissett I. Development of a risk stratification system for the occurrence of prolonged postoperative ileus after colorectal surgery: a prospective risk factor analysis. Surgery. 2015;157(4):764-73. https://doi.org/10.1016/j.surg.2014.12.005
  17. Tarrant RC, Lynch S, Sheeran P, O'Loughlin PF, Harrington M, Moore DP, et al. Low body mass index in adolescent idiopathic scoliosis: relationship with pre-and postsurgical factors. Spine. 2014;39 (2): 140-8. https://doi.org/10.1097/BRS.0000000000000081
  18. Al Maaieh MA, Du JY, Aichmair A, Huang RC, Hughes AP, Cammisa FP. et al. Muitivariate analysis on risk factors for postoperative ileus after lateral lumber interbody fusion. Spine. 2014;39(8):688-94. https://doi.org/10.1097/BRS.0000000000000238
  19. Qureshi R, Puvanesarajah V, Jain A, Shimer AL, Shen FH, Hassanzadeh H. Comparison of anterior and posterior lumbar interbody fusions. Spine. 2017; 42(24):1865-70. https://doi.org/10.1097/BRS.0000000000002248
  20. Bonnet F, Marret E. Influence of anaesthetic and analgesic techniques on outcome after surgery. British Journal of Anaesthesia. 2005;95(1):52-8. https://doi.org/10.1093/bja/aei038
  21. Lee KM, Bae JW, Kim YH, Lim SH, Lee JH, Cheong SH, et al. Effect of anesthetic methods on gastrointestinal bowel movement after colon surgery. Korean Journal of Anesthesiology. 2006;51(6):659-62. https://doi.org/10.4097/kjae.2006.51.6.659
  22. Rees J, Bobridge K, Cash C, Lyons-Wall P, Allen R, Coombes J. Delayed postoperative diet is associated with a greater incidence of prolonged postoperative ileus and longer stay in hospital for patients undergoing gastrointestinal surgery. Nutrition and Dietetics. 2018;75(1):24-9. https://doi.org/10.1111/1747-0080.12369
  23. Chapuis PH, Bokey L, Keshava A, Rickard MJF, Stewart P, Young CJ, et al. Risk factors for prolonged ileus after resection of colorectal cancer: an observational study of 2400 consecutive patients. Annals of Surgery. 2013;257(5):909-15. https://doi.org/10.1097/SLA.0b013e318268a693
  24. Murphy MM, Tevis SE, Kennedy GD. Independent risk factors for prolonged postoperative ileus development. Journal of Surgical Research. 2016;201(2): 279-85. https://doi.org/10.1016/j.jss.2015.10.047
  25. Vather R, Trivedi S, Ian Bissett I. Defining postoperative ileus: results of a systematic review and global survey. Journal of Gastrointestinal Surgery. 2013;17(5):962-72. https://doi.org/10.1007/s11605-013-2148-y
  26. Park JH, Yun SO, Kim SH, Yu MG, Ham EJ. Constipation in patients following orthopedic surgery: incidence and influencing factors. Journal of Korean Academic Society of Adult Nursing. 2016;28(6): 637-45. https://doi.org/10.7475/kjan.2016.28.6.637
  27. Stienen MN, Smoll NR, Hildebrandt G, Schaller K, Tessitore E, Gautschi OP. Constipation after thoraco-lumbar fusion surgery. Clinical Neurology and Neurosurgery. 2014;126:137-42. https://doi.org/10.1016/j.clineuro.2014.08.036
  28. Suk SI, Kim JH, Kim SS, Kim JH, Cho BC, Jung NY. Aprotinin reduced blood loss in spinal deformity surgery. Journal of Korean Orthopaedic Association. 2007;42(3):318-23. https://doi.org/10.4055/jkoa.2007.42.3.318
  29. Kim YT, Cho KJ, Kim GH, Choi JH. Effectiveness of tranexamic acid in reducing blood loss after spinal fusion. Journal of Korean Orthopaedic Association. 2014;49(3):195-201. https://doi.org/10.4055/jkoa.2014.49.3.195
  30. Artinyan A, Nunoo-Mensah JW, Balasubramaniam S, Gauderman J, Essani R, Gonzalez-Ruiz C, et al. Prolonged postoperative ileus-definition, risk factors, and predictors after surgery. World Journal of Surgery. 2008;32(7):1495-500. https://doi.org/10.1007/s00268-008-9491-2
  31. Weimann A, Braga M, Harsanyi L, Laviano A, Ljungqvist O, soetersp P et al. ESPEN guidelines on enteral nutrition: surgery including organ transplantation. Clinical Nutrition. 2006;25(2):224-44. https://doi.org/10.1016/j.clnu.2006.01.015
  32. Fujii T, Sutoh T, Kigure W, Morita H, Katoh T, Yajima R, et al. C-reactive protein level as a possible predictor for early postoperative ileus following elective surgery for colorectal cancer. Hepatogastroenterology. 2015;62(138):283-5. https://doi.org/10.5754/hge12320
  33. Maruna P, Frasko R, Gurlich R. Plasma procalcitonin in patients with ileus. Relations to other inflammatory parameters. Physiological Research. 2008;57(3):481-6. https://doi.org/10.33549/physiolres.931249
  34. Bateman DK, Millhouse PW, Shahi N, Kadam A, Maltenfort M, Koerner JD, et al. Anterior lumbar spine surgery: a systematic review and metaanalysis of associated complications. Spine Journal. 2015;15 (5):1118-32. https://doi.org/10.1016/j.spinee.2015.02.040
  35. Rao PJ, Loganathan A, Yeung V, Mobbs RJ. Outcomes of anterior lumbar interbody fusion surgery based on indication: a prospective study. Neurosurgery. 2015;76(1):7-24. https://10.1227/NEU.0000000000000561
  36. Lee IS, Choi JS, Park CH, Lee SC, Kim WT. The effect of lidocaine and ketorolac combined to fentanyl IV PCA on postoperative bowel function. Korean Journal of Anesthesiology. 2001;40(6):745-50. https://doi.org/10.4097/kjae.2001.40.6.745