胰瘘患者带管出院后再次入院危险因素分析

Analysis of risk factors for readmission of hospital of discharge patients with drainage tube placement due to postoperative pancreatic fistula

目的探讨胰腺手术后胰瘘带管出院患者的门诊随访要点,分析患者再次入院的危险因素。方法收集2014年9月至2017年6月我院胰腺切除术后胰瘘携带引流管出院后于门诊随访患者共47例,分析患者再次入院的危险因素。结果47例患者中门诊随访再次入院12例(25.5%),其主要入院原因包括积液伴感染加重5例(41.7%),引流管意外脱落3例(25%),腹腔出血2例(16.7%),肠瘘1例(8.3%),消化道梗阻1例(8.3%)。多因素Logistic回归分析显示,高龄(P=0.048)、体质量指数过低(P=0.019)、出院时引流液浑浊(P=0.049)是胰瘘患者带管出院后再次入院的独立危险因素。结论需重视胰腺术后胰瘘带管出院患者的观察治疗,尤其是高龄、体质量指数过低、出院时引流液浑浊者,需警惕腹腔感染加重、引流管意外脱落、腹腔出血等导致再次入院的外科相关问题。

Objective To explore the key points of followed-up outpatients who were discharged hospital with drainage tube placement due to postoperative pancreatic fistula and to analyze the risk factors for readmission.Methods Clinical data of 47 followed- up hospital discharge patients with drainage tube placement due to postoperative pancreatic fistula in our hospital between September 2014 and June 2017 were collected.The risk factors for readmission were retrospectively analyzed.Results Of the 47 patients, 12 （25.5% ） were readmitted.The main courses of readmission included peritoneal fluid and infection aggravate in 5 patients （41.7% ） , drainage tube accidental fall off in 3 patients （25% ）,abdominal cavity hemorrhage in 2 patients （16.7% ）,intestinal fistula in 1 patient （8.3%） and digestive tract obstruction in 1 patient （8.3%）. The multiple logistic regression analysis showed that aged （P=0.048 ） ,lower body mass index （P=0.019 ） and turbid drainage fluid at hospital discharge （P=0.049） were risk factors of unsched-uled readmission.Conclusion It is needed to pay attention to hospital discharge patients with drainage tube placement due to postop-erative pancreatic fistula,especially for the aged,lower body mass index and turbid drainage fluid at hospital discharge.It needs to be mindful for surgical factors associated with hospital readmission such as peritoneal fluid and infection aggravate, drainage tube accidental fall off,abdominal cavity hemorrhage,etc.