绞窄性肠梗阻预测指标的多因素分析

Multivariate analysis of the indicators of strangulating intestinal obstruction

目的:探索绞窄性肠梗阻的预测指标。方法:采用χ2检验及非条件Logistic回归对2000年1月至2010年12月某医院普外科收治的269例肠梗阻手术病例的临床资料进行回顾性分析。结果:绞窄性肠梗阻患者176例,非绞窄性肠梗阻患者93例。CT检查结果中,肠壁不强化或弱强化是绞窄性肠梗阻的主要预测指标(OR=40.950,P<0.001),腹水、条索状脂肪的OR值分别为7.375、5.732(P=0.001);实验室指标WBC数量预测绞窄的OR值为7.423(P=0.002);临床症状及体征中,仅腹膜刺激征OR值为5.426(P=0.002);有腹部手术史患者较易发生非绞窄梗阻(OR=0.046,P<0.001)。结论:预测绞窄的主要指标是肠壁不强化或弱强化。但腹水、条索状脂肪、腹膜刺激征、WBC数量以及患者腹部手术史也是判断绞窄的重要参数。

Objective To investigate the prognostic indicators of strangulating intestinal obstruction. Methods Medical data of 269 patients which had received operation of strangulating intestinal obstruction in the hospital from Jan. 2000 to Dec. 2010 was analyzed by. chi-squared tests, and a logistic regression model. Results 176 patients with strangulating intestinal obstruction, and 93 patients with no strangulating intestinal obstruction. The most significant independent predictor of strangulating intestinal obstruction was the computed tomography （CT） finding of reduced wall enhancement （OR = 40.950,P 〈 0.001 ）. The OR of ascites and fat stranding were 7.375 and 5.732 （P = 0.001）; Elevated white blood cell （WBC） count and guarding were moderately predictive （OR 7.423 and 5.426）; Previous operation was also a most significant predictor （OR = 0.046, P 〈 0.001）. Conclusion Regression analysis demonstrates that reduced wall enhancement on CT was a mainly predictor. But ascites, fat stranding, guarding and elevated WBC are also the important variables for predicting the bowel strangulation in patients.