选择性断流术治疗门静脉高压症影响因素的回归分析

Analysis of risk factors for selective devascularization in patients with portal hypertension

目的探讨影响选择性断流术治疗门静脉高压症术后转归的因素。方法回顾性分析接受选择性断流术的160例门静脉高压症患者的临床资料，根据术后并发症的发生情况将患者分为高危组和低危组。并将其作为因变量，将32个围手术期的临床指标作为自变量，进行回归分析。结果单因素分析显示：在高危组和低危组中，黄疸史、Child-Turcotte-Pugh分级、术前总胆红素、凝血酶原时间延长值、切脾前自由门静脉压、腹水量、术后1周白细胞计数和术后1周血红蛋白水平均有显著差异（P〈0．05）。多因素分析显示：自由门静脉压的降幅、术前总胆红素、凝血酶原时间延长值、腹水量、术后1周白细胞计数及术后1周血红蛋白水平在两组间差异有统计学意义（χ^2=53．337，P〈0．01）。结论影响选择性断流术治疗门静脉高压症预后的因素为自由门静脉压的降幅、术前总胆红素、凝血酶原时间延长值、腹水量、术后1周白细胞计数和术后1周血红蛋白水平。

Objective To investigate the risk factors for selective devascularization in patients with portal hypertension. Methods The clinical data of 160 patients with portal hypertension underwent selective devascularization were retrospectively analyzed. All the patients were divided into high-risk group and low-risk group according to the postoperative complications. Thirty-two clinical factors were analyzed using logistic regression. Results Single-factor analysis showed that history of jaundice, Child-Turcotte-Pugh classification, total bilirubin （before the operation）, prolongation of prothrombin time, pre-operative free portal pressure, ascites, leukocyte count （ 1 week after the operation） and hemoglobin （ 1 week after the operation） were significantly different between the high-risk group and low-risk group（ P 〈 0. 05 ）. Logistic regression analysis showed that decrease of free portal pressure, total bilirubin （ before the operation）, prolongation of prothrombin time, ascites, leukocyte count （ 1 week after the operation） and hemoglobin （ 1 week after the operation ） were still significantly different between the two groups （χ^2 = 53. 337, P 〈 0. 01 ）. Conclusions The risk factors of selective devascularization in patients with portal hypertension are decrease of free portal pressure, pre-operative total bilirubin, prolongation of prothrombin time, ascites, post-operative leukocyte count and hemoglobin.