胃癌术后影响胃瘫发生的多因素分析

Analysis of Multiple Factors for Gastric Paralysis Following Gastrectomy of Gastric Cancer

目的探讨胃癌术后影响胃瘫发生的危险因素并分析其原因。方法回顾性分析了2011年10月至2013年10月期间我院普外科因不同原因导致胃癌手术后住院时间单次超过21 d的116例患者的临床资料,其中胃癌术后发生胃瘫的患者16例,未发生胃瘫患者100例。结合文献对可能影响胃瘫发生的有关因素进行非条件logistic回归分析。结果经单因素分析结果显示,胃癌患者的术前体重指数、有无糖尿病史、手术时间、术后心血管并发症、术后3 d内白蛋白水平、术后3 d内血红蛋白水平、术后开始下床活动时间、胃管拔除时间、首次饮水时间及首次进食时间与胃癌术后胃瘫发生有关(P<0.05),而性别、年龄、糖尿病史的时间长短、生活方式、有无吸烟史、有无高血压病史、是否保留幽门、是否行腹腔镜、术中出血量、术中是否输血、术中是否使用腹腔化疗药物、消化道重建方式、术后是否使用镇痛药及空肠营养管留置时间与胃癌术后胃瘫发生无关(P>0.05);进一步行非条件logistic回归分析发现,胃癌患者的术前体重指数、有无糖尿病史、手术时间、术后开始下床活动时间及术后心血管并发症是影响胃癌术后发生胃瘫的危险因素(P<0.05)。结论胃癌术后影响胃瘫发生的因素较多,临床上可以根据可能影响胃瘫发生的因素采取积极的预防措施,以减少胃瘫的发生。

Objective To explore risk factors of gastric paralysis following gastrectomy of gastric cancer and analyze its causes. Methods The clinical data of 116 patients with gastric cancer for hospitalization time more than 21 days following gastrectomy were retrospectively analyzed from October 2011 to October 2013 in this hospital, in which 16 patients with gastric paralysis and 116 patients without gastric paralysis. The factors relevant gastric paralysis were analyzed by logistic regression analysis. Results The results of single factor analysis showed that the preoperative body mass index, history of diabetes, operative time, postoperative cardiovascular complications, albumin and hemoglobin levels within 3 d after operation, time to get out of bed after surgery, extubation time of gastric tube, the first drinking time and the first feeding time were associated with the gastric paralysis （P〈0.05）, but the gender, age, time of diabetes history, life mode, smoking history, hypertension history, pylorus preserving or not, laparoscopy or not, intraoperative blood loss, intraoperative blood transfusion, uses of postoperative intraperitoneal chemotherapy drugs and postoperative analgesic drugs, and indwelling time of jejunum nutrition tube were not associated with gastric paralysis （P〉0.05）. The results of logistic regression analysis showed that the preoperative body mass index, history of diabetes, operative time, time to get out of bed after surgery, and postoperative cardiovascular complications were the independent risk factors of gastric paralysis （P〈0.05）. Conclusions There are many factors that affect occurrence of gastric paralysis following gastrectomy of gastric cancer. Preoperative or intraoperative positive prevention measures could be taken according to the factors that might affect occurrence of gastric paralysis, which might be reduce gastric paralysis following gastrectomyof gastric cancer.