食管异物并发症的影响因素分析

Complications related factors in patients with esophageal foreign bodies

目的探讨食管异物并发症发生的相关因素，为降低食管异物并发症的发生和进行有效的临床处理提供指导。方法选取1997年5月至2014年9月于某院就诊的414例食管异物患者为研究对象，采用病例对照的研究方法，以食管异物患者中发生并发症者为病例组，未发生并发症者为对照组。比较两组人群基本特征及入院后治疗情况的差异，并采用多因素logistic回归分析探究食管异物患者发生并发症的相关因素。结果414例食管异物患者中60侈寸发生了黏膜损伤，22例发生了穿孔；老年人群占食管异物患者总人数的35．5％。1）多因素logistic回归分析显示，并发症的发生与异物性质、来诊时间存在关联（P〈0．01）；与误食兽骨比较，摄入枣核的病人出现并发症的风险是前者的3．016倍（OR=3．016，95％CI：1．578～5．763）；出现食管异物后48小时及以上时间来诊者发生并发症的风险是12小时内就诊患者的2．186倍（OR=2．186，95％CI：1．134-4．213）。2）发生并发症组进行开食管或开胸治疗的比例高于对照组（P〈0．01）；3）有并发症组术后进食时间更长（P〈O．05），其住院时间及术后出院时间均比对照组多约2天。结论出现食管异物应及时就诊，并综合异物的性质和患者的情况选取正确的治疗方式，将有利于降低并发症的发生风险、加快患者康复速度、减少住院总时间。

Objective A retrospective study was conducted to investigate the related factors of complications in patients with esophageal foreign bodies （EFBs）, and to lower the incidence of complications and improve treatment efficacy. Methods From May 1997 to September 2014, 414 cases with EFBs at our hospital were enrolled in the study group. Using the patients with complications as the subjects and patients with no complications as the controls, a case-control study was designed to compare the differences between their characteristics and treatments. Applying multivariate conditional logistic analysis, we probed the risk factors of complications. Results Of all the 414 cases, 60 （ 15.0% ） individuals appeared esophageal mucosa injury and 22 （5.3%） individuals appeared esophageal perforation. Multivariate conditional logistic analysis indicated that type of EFBs and duration of impaction were associated with complications in patients with EFBs （ P〈0. 01 ）. Compared to animal bone, date pit was more likely to cause complications （OR=3. 016,95% CI= 1. 578-5. 763）. It also showed that the interval time from impac- tion to seeking medical care was the related factor of complications. Patients who saw a doctor after more than 48 hours were more easily to arise complications （ OR = 2. 186,95 % CI= 1.134-4. 213 ）. For subjects, the ratio of surgical treatment was higher than controls （P〈0.01）. Compared to controls, subjects improved the feeding （P〈0.05） and shortened the time of length of stays and postoperative recovery by about two days, respectively. Conclusion Patients with EFBs should seek hospital treatment as soon as possible. Clinical doctors should consider various data, especially type of EFBs and interval time. Accurate treatment and selective surgery may prevent serious complications and shorten the time of postoperative recovery and length of stays.