胃肠微创手术患者发生高淀粉酶血症的危险因素分析

Risk factors of hyperamylasemia in patients with gastrointestinal minimally invasive surgery

目的 探讨胃肠微创手术患者术后并发高淀粉酶血症的相关危险因素.方法 收集2012年1月至2014年1月在我院普外科行胃肠微创手术的220例患者的临床资料,根据患者术后血清淀粉酶水平是否正常将其分为血淀粉酶正常组及高淀粉酶血症组,对比分析两组并发症发生情况.采用单因素及Logistic多因素分析引起高淀粉酶血症的危险因素.结果 220例患者术后并发高淀粉酶血症98例（44.54％,98/220）,其中结肠手术45例,胃部手术53例.高淀粉酶组发生并发症28例（28.57％,28/98）,淀粉酶正常组发生并发症8例（6.56％,8/122）,两组比较差异有统计学意义（x2=4.869,P=0.006）.单因素分析显示,两组上腹部手术、手术方式、BMI＞ 25 kg/m2、手术时间、手术体位、CO2气腹压力、气腹持续时间、胰腺处理方式比较差异均有统计学意义（P均＜ 0.05）.经Logistic多因素分析显示两组上腹部手术、CO2气腹压力、气腹持续时间、手术时间是引起高淀粉酶血症的独立危险因素.结论 胃肠腹腔镜术后高淀粉酶血症发生率较高,其中胰腺炎、术后切口感染患者术后更容易并发高淀粉酶血症.上腹部手术、CO2气腹压力、气腹持续时间、手术时间是引起高淀粉酶血症的独立危险因素.

Objective To investigate the risk factors of hyperamylasemia in patients with gastrointestinal minimally invasive surgery.Methods Two hundred and twenty cases with gastrointestinal were selected as our subjects who were hospitalized in General Surgery Department of the Center Hospital of Binzhou from Jan 2012 to Jan 2014.The patients were divided into normal group and hyperamylasemia group according to the postoperative serum amylase levels.The complications of two groups were recorded.The risk factors of hyperamylasemia were analyzed with univariate and Logistic multivariate.Results There were 98 cases （44.54％,98/220） of concurrent hyperamylasemia,45 cases （20.45 ％） of colon surgery,53 cases （24.09％） of stomach surgery.The complications of hyperamylasemia group and normal group were 28 cases （28.57％） and 8 cases （6.56％）,and the difference was significant （x2 =4.869,P =0.006）.Univariate analysis showed that there were significant differences in terms of the abdominal surgery,surgical approach,body mass index ＞ 25 kg/m2,operation time,position,CO2 insufflation pressure,pneumoperitoneum duration and pancreatic treatment between two groups（P ＜ 0.05）.Logistic multivariate analysis showed that the abdominal surgery,CO2 insufflation pressure,pneumoperitoneum duration and operative time were independent risk factors with hyperamylasemia.Conclusion There is high incidence of hyperamylasemia after laparoscopic gastrointestinal surgery.Patients with pancreatitis and postoperative infection are easily to get hyperamylasemia complications.Upper abdominal surgery,CO2 insufflation pressure,pneumoperitoneum duration,operative time are independent risk factors for hyperamylasemia.