绞窄性肠梗阻的危险因素以及手术时机选择与手术效果的研究

Analysis on the Risk Factors of Strangulated Intestinal Obstruction and Correlation between Operation Time and Operation Effect

目的研究绞窄性肠梗阻的危险因素以及手术时机选择与手术效果的关系。方法将2010年1月至2013年10月绵阳市中心医院普外科收治的肠梗阻患者纳入研究,根据手术时机不同分为绞窄性肠梗阻组（78例）和单纯性肠梗阻组（92例）,分析早期诊断指标,观察术后恢复情况。结果体温高（OR=2.948,95%CI 1.878-4.232）、心率快（OR=3.485,95%CI 2.482-4.785）、腹痛持续时间长（OR=2.452,95%CI 1.285-3.523）、腹膜刺激征（OR=7.875,95%CI 6.447-9.457）、C反应蛋白（OR=3.445,95%CI 2.270-4.795）、白细胞介素1（OR=11.477,95%CI 9.587-13.237）和白细胞介素6水平高（OR=9.423,95%CI 7.849-10.899）、腹部手术史（OR=13.594,95%CI 3.104-5.423）是绞窄性肠梗阻发生的危险因素（P〈0.05）。单纯性肠梗阻患者术后肛门排气时间、卧床时间显著低于绞窄性肠梗阻患者[（1.9±0.4）d比（3.4±0.7）d,（4.8±0.8）d比（7.4±1.1）d,P〈0.05]。单纯性肠梗阻患者术后1 d数字评价量表（NRS）评分为（2.8±0.5）分、术后3 d NRS疼痛评分（1.9±0.3）分、术后5 d NRS疼痛评分（1.2±0.2）分,绞窄性肠梗阻患者术后1 d NRS评分（4.8±0.7）分、术后3 d NRS疼痛评分（4.1±0.6）分、术后5 d NRS疼痛评分（2.7±0.5）分,单纯性肠梗阻患者与绞窄性肠梗阻患者治疗前后与处理存在交互作用（均P〈0.05）。结论腹膜刺激征、白细胞介素1和白细胞介素6水平可作为判断和预测绞窄性肠梗阻的可靠指标,指导早期诊断、及时手术,改善患者预后。

Objective To study the risk factors of strangulated intestinal obstruction and correlation between operation time and operation effect.Methods A total of 180 patients with intestinal obstruction admitted in General Surgery Department of Mianyang Central Hospital from Jan.2010 to Oct.2013 were selected and divided into strangulated intestinal obstruction group（78 cases） and simple intestinal obstruc-tion group（92 cases） according to different operation time.Then early diagnostic indexes of the two groups were analyzed and postoperative recovery conditions were observed.Results High temperature （ OR =2.948,95%CI 1.878-4.232）,rapid heart rate（OR=3.485,95%CI 2.482-4.785）,long duration of ab-dominal pain （OR=2.452,95%CI 1.285-3.523）,peritoneal irritation sign（OR =7.875,95%CI 6.447-9.457）,and C reactive protein（OR=3.445,95%CI 2.270-4.795）,interleukin 1（OR =11.477,95%CI 9.587-13.237）,interleukin 6（OR =9.423,95%CI 7.849-10.899）,abdominal operation history（OR =13.594,95%CI 3.104-5.423） were the risk factors of strangulated intestinal obstruction（P 〈0.05）.The postoperative anal exhaust time,bed rest time of simple intestinal obstruction group was lower than strangula-ted intestinal obstruction group [（1.9 ±0.4） d vs （3.4 ±0.7） d,（4.8 ±0.8） d vs （7.4 ±1.1） d,P〈0.05].In simple intestinal obstruction group, numeric rating scales （NRS） score 1 d after operation was （2.8 ±0.5）,NRS score 3 d after operation was （1.9 ±0.3）, NRS scores 5 d after operation was （1.2 ± 0.2）;while in strangulated intestinal obstruction group,NRS score 1 d after operation was （4.8 ±0.7）, NRS score 3 d after operation was （4.1 ±0.6）,NRS score 5 d after operation was （2.7 ±0.5）;it showed that there was exchange interaction between before and after treatment in simple intestinal obstruction patients and strangulated intestinal obstruction patients （all P〈0.05）.Conclusion Peritoneal irritation sign,IL-1 and IL-6 levels can be used as reliable indicators to judge and predict strangulated intestinal obstruction and guide early diagnosis and timely operation,in order to improve the prognosis of the patients.