直肠癌患者术后应激性溃疡出血影响因素分析

Risk factors associated with stress ulcer bleeding in postoperative rectal cancer patients

目的探讨直肠癌患者术后发生应激性溃疡出血（SUB）的影响因素。方法回顾性分析天津市人民医院结直肠外科收治的直肠癌手术患者临床资料．根据其术后是否发生SUB将其分为SUB组（58例）和对照组（402例），采用单因素和多因素分析的方法研究发生SUB的影响因素。结果SUB组患者术前各项慢性疾病发病率均高于对照组（P〈0．01和P〈0．05）：除肾功能不全外．SUB组患者的各种术后并发症发生率也均高于对照组（P〈0．05）。单因素和多因素分析结果显示．高龄（OR=2．893，95％CI：1．118～5．543）、饮酒史（OR=3．839．95％CI：1．012～6．654）、术前患有慢性疾病（OR=4．646，95％C1：1．872-8．892）、术中出血量大（DR=5．129，95％CI：2．829～9．328）、术后发生严重并发症（OR=6．576，95％CI：4．539～13．278）、术后应用糖皮质激素（OR=2．978，95％CI：1．013～4．512）和术前应用非甾体类抗炎药物（DR=2．126，95％CI：1．287～7．636）是导致患者术后发生SUB的危险因素：术后预防性使用制酸剂（OR=0．102，95％CI：0．017～0．196）是患者术后发生SUB的保护因素。结论应对发生SUB的高危患者加强监护并积极采取有效措施进行预防以改善其预后。

Objective To explore the influence factor of stress ulcer bleeding （SUB） in postoperative rectal cancer patients. Methods Clinical data of rectal cancer patients undergoing operation in our hospital were analyzed retrospectively. Patients were divided into case group and control group according to the postoperative occurrence of SUB. Univariate analysis combined with multivariate analysis were used to evaluate the influence factors. Results than that of control group. Except for renal failure Chronic diseases incidence of case group was higher the incidence of postoperative complications of case group was higher than that of control group. Univariate analysis revealed that age, chronic disease, preoperative, and postoperative complications had statistical significant differences （P〈0.05）. Multivariate analysis identified that age（OR=2.893, 95%CI. 1.118-5.543）, drinking history（OR=3.839, 95%CI-1.012- 6.654）, preoperative chronic disease（OR=4.646, 95%CI： 1.872-8.892）, intraoperative bleeding volume （OR= 5.129, 95%CI： 2.829-9.328）, occurrence of severe complications after surgery （OR=6.576, 95%CI： 4.539- 13.278）, postoperative application of glucocorticoid （OR =2.978, 95% CI：1.013-4.512）, preoperative application of non-steroidal anti-inflammatory drugs（OR=2.126, 95%CI： 1.287-7.636） were risk factors for SUB in rectal cancer patients after operation. Postoperative prophylactic use antacids（OR=0.102, 95%CI. 0.017-0.196） was protective factor for SUB patients. Conclusion Effective measures should be taken for high-risk patients, in order to improve the prognosis of patients.