急性肠系膜缺血性疾病肠切除术后并发症的危险因素分析

Analysis of risk factors of complications after bowel resection in acute mesenteric ischemic disease

目的研究急性肠系膜缺血性疾病(AMI)行肠切除术后并发症的危险因素。方法采用回顾性病例对照研究方法,分析中国人民解放军总医院第一医学中心2010年1月—2020年1月确诊为AMI并行肠切除术的68例患者的病例资料,其中男性43例,女性25例,根据患者术后是否出现并发症分为并发症组(n=21)和非并发症组(n=47)。对术后出现并发症的相关危险因素进行多因素Logistic逐步回归方法分析,判断具有临床意义的风险因素。正态分布的计量资料以均数±标准差(x±s)表示,组间比较采用t检验。计数资料组间比较采用χ^(2)检验。结果单因素分析结果显示:年龄>60岁、Marshall评分≥2分、切除肠管类型、病理提示为不可逆性透壁性坏死、ICU住院时间>6 d、机械通气时长>2 d、美国麻醉医师协会(ASA)分级、术前降钙素原≥2 ng/mL是影响AMI肠切除术后并发症发生的危险因素(P<0.05)。多因素Logistic回归分析结果显示,年龄>60岁(HR=12.364,95%CI:1.135~134.662,P=0.039),术前降钙素原≥2 ng/mL(HR=14.144,95%CI:1.280~156.303,P=0.031)为AMI行肠切除后发生并发症的独立危险因素。结论AMI合并肠切除术后发生并发症的概率较高,当患者合并年龄>60岁及术前降钙素原≥2 ng/mL的情况时,术前应重视术后并发症的预防,提高患者的预后。

Objective To study the risk factors of complications after bowel resection for acute mesenteric ischemic disease.Methods Retrospective case-control study was used to analyze the case data of 68 patients diagnosed with acute mesenteric ischemic disease(AMI)with bowel resection at the First Medical Center of the PLA General Hospital from January 2010 to January 2020,including 43 males and 25 females.The patients were divided into complication group(n=21)and the non-complication group(n=47)according to whether they had complications after surgery.The risk factors associated with the development of postoperative complications were analyzed by multivariate Logistic stepwise regression method to determine the risk factors with clinical significance.Measurement data with normal distribution were expressed as mean±standard deviation(x±s),and t-test was used for comparison between groups.Chi-square test was used for comparison between count data groups.Results Univariate analysis showed that age>60 years,Marshall score≥2,type of resected bowel,pathology suggestive of irreversible transmural necrosis,length of ICU stay>6 d,length of mechanical ventilation>2 d,American Society of Anesthesiologists(ASA)classification,and preoperative procalcitonin≥2 ng/mL were the risk factors affecting the development of complications after bowel resection for acute mesenteric ischemic disease risk factors(P<0.05).Multivariate Logistic regression analysis showed that age>60 years(HR=12.364,95%CI:1.135-134.662,P=0.039)and preoperative procalcitonin≥2 ng/mL(HR=14.144,95%CI:1.280-156.303,P=0.031)were independent risk factors for the development of postoperative complications after AMI parallel bowel resection.Conclusion The rate of complications after combined bowel resection for AMI is high.When patients are combined with age>60 years and preoperative procalcitonin≥2 ng/mL,preoperative prevention of postoperative complications should be emphasized to improve the prognosis of patients.