恶性梗阻性黄疸患者围手术期出血高危因素分析

Study of risk factors for bleeding in patients with maligant obstructive jaundice during the perioperative period

目的 探索恶性梗阻性黄疸手术围手术期出血的高危因素。方法 回顾性分析 2 6 9例患者的一般临床资料、实验室检查结果、术中情况及术后并发症的发生情况 ,应用SAS统计软件进行Logistic回归分析。结果 2 0例 (占 7.4 % )患者围手术期发生出血并发症。Logistic回归分析发现导致围术期出血的高危因素有 :根治性手术方式 ,既往病史 (高血压、糖尿病、冠心病、溃疡病 ) ,术前低蛋白血症和血小板减少症。结论 对有高危因素者术前应控制原发病 ,将血浆白蛋白提高至 30g/L以上 ,提高血小板计数水平 ;术后对实施根治性手术、有既往病史等高危因素的患者应密切观察 ,做到早期发现 ,及时处理。

Objective To investigate the high risk factors of hemorrhage in patients with malignant obstructive jaundice during perioperative period.Methods Data were collected from 269 patients including clinical data, experiment results, complications during and after operation. The data were analyzed with logistic stepwise regression analysis.Results Among them, hemorrhage happened in 20 patients (7.4%). According to stepwise regression analysis, the risk factors for hemorrhage after operation included radical operation, suffering from severe accompanied diseases (such as hypertension, diabetes, coronary heart disease or ulcer), albumin<30g/L and thrombocytopenia before operation. Conclusions Preoperative preparation for the patients should be optimized, including controlling the severe accompanied diseases and increasing albumin up to 30g/L. Meticulous attention should be paid to details during the operation,and continuous close observation should be given.