摘要
目的:探讨穿透型克罗恩病(CD)术后并发症发生的风险和保护性因素,以期改进术前管理。方法:回顾我科收治的154例接受肠切除吻合手术的穿透型CD病人的临床资料,采用Logistic回归模型分析术后并发症发生的风险和保护性因素。结果:手术后有20例(12.9%)病人出现并发症。多变量分析显示,术前C反应蛋白(CRP,P=0.028,A值:1.687,95%CI:1.059~2.687)是术后并发症发生的风险性因素,且CRP的分界值为26.5 mg/L(P=0.000),敏感性为85.0%,特异性为93.3%。术前营养支持(P=0.021,A值:0.001,95%CI:0.000~0.341)和骨骼肌含量(SMM,P=0.027,A值:0.172,95%CI:0.036~0.815)是术后并发症发生的保护性因素,且SMM的分界值为17.4 kg(P=0.000),敏感性为95.0%,特异性为80.6%。结论:术前应尽可能降低CD的炎性活动,并进行营养支持,以改善病人的营养状况。SMM可作为预测参数,从而改进术前管理、降低术后并发症的发生率。
Objective: The study was to explore the risk and protective factors for postoperative complications in penetrating Crohn's disease( CD). Methods: 154 patients with penetrating CD were collected and analyzed. Results: Postoperative complications occurred in 20 /154( 12. 9%). In the multivariate analysis,preoperative C-reactive protein( CRP,P = 0. 028,A: 1. 687,95% CI: 1. 059 ~2. 687) was a significantly independent risk factor for postoperative complications,and the cut-off value of CRP was 26. 5mg / L( P = 0. 000,sensitivity 85. 0%,specificity 93. 3%). Preoperative nutrition support( P = 0. 021,A: 0. 001,95% CI: 0. 000 ~ 0. 341) and skeletal muscle mass( SMM,P = 0. 027,A:0. 172,95% CI: 0. 036 ~ 0. 815) were significantly independent protective factors for postoperative complications,and the cut-off value of SMM was 17. 4 kg( P = 0. 000,sensitivity 95. 0%,specificity80. 6%). Conclusion: The inflammatory activity should be controlled and the nutritional support must be provided before operation in indicated penetrating CD patients. SMM may be an appropriate predictor.
出处
《肠外与肠内营养》
北大核心
2015年第6期321-324,共4页
Parenteral & Enteral Nutrition
基金
国家自然科学基金资助(81570500
81200263)
关键词
克罗恩病
术后并发症
C-反应蛋白
营养支持
骨骼肌含量
Crohn's disease
Postoperative complication
C-reactive protein
Nutritional support
Skeletal muscle mass