脾切除加贲门周围血管离断术死亡的危险因素分析

Analysis of risk factors associated with mortality after splenectomy with periesophagogastric devascularization

目的明确脾切除加贲门周围血管离断术发生死亡的危险因素,以降低死亡率。方法回顾性分析2001年2月—2010年3月间在我院接受脾切除加贲门周围血管离断术连续217例患者的病历资料。应用SPSS软件对相关数据进行单变量及多变量分析。结果 217例脾切除加贲门周围血管离断术后死亡率为6.0%。经逻辑回归多变量分析确定了7个独立与死亡相关的因素,即急诊手术(OR=70.300)、肌酐(OR=50.911)、Child分级(OR=33.988)、肝性脑病(OR=27.524)、年龄(OR=15.719)、白蛋白(OR=9.458)及总胆红素水平(OR=6.890)。死亡的预测方程为:P=1/[1+e-(-9.723+4.253急诊手术+3.930肌酐+3.526Child分级+3.315肝性脑病+2.755年龄+2.247白蛋白+1.930总胆红素)]。结论脾切除加贲门周围血管离断术死亡的危险因素为急诊手术、肌酐≥176.8μmol/L、Child分级为C级、肝性脑病、年龄≥65岁、白蛋白<30g/L及总胆红素≥34.2mmol/L。

Objective To determine the risk factors associated with death after splenectomy with periesophagogastric devascularization（SPD）in order to decrease the mortality. Methods The data of 217 consecutive patients undergone SPD in our hospital from Feb.2001 to Mar.2010 were analyzed retrospectively.Univariate and multivariate analysis were performed on the data by SPSS software. Results The mortality of 217 cases undergone SPD was 6.0%.Multivariate analysis using logistic regression identified seven variables as independent factors associated with the mortality,they were emergency SPD（OR=70.300）,creatinine（OR=50.911）,Child classification（OR=33.988）,hepatic encephalopathy（OR=27.524）,age（OR=15.719）,albumin（OR=9.458） and total bilirubin（OR=6.890）.Predictive equation was P=1/[1＋e-（-9.723＋4.253 emergent SPD ＋3.930 creatinine ＋3.526Child grade ＋3.315 hepatic encephalopathy ＋2.755 age ＋2.247 albumin ＋1.930 total bilirubin） ]. Conclusions The risk factors for mortality after SPD are emergent SPD,creatinine more than or equal to176.8μmol/L,Child class C,hepatic encephalopathy,age more than or equal to 65 years,albumin less than 30 g/L and total bilirubin more than or equal to 34.2mmol/L.