胰十二指肠切除术后出血的影响因素分析与护理对策

Analysis of influencing factors and nursing strategies on postoperative hemorrhage of pancreaticoduodenectomy

目的探讨胰十二指肠切除(PD)术后出血的影响因素与护理措施。方法回顾性分析我院2015年10月到2018年9月205例PD患者的临床资料,观察术后出血情况,采用多因素logistic回归分析PD术后出血的独立危险因素。结果205例患者中43例发生术后出血,162例未发生术后出血。性别、胰腺空肠吻合方式、慢性病史、术后引流液量、腹腔感染、胰瘘、胆瘘、急性肾衰竭、胃潴留对术后出血的影响无统计学意义(P>0.05);术后出血组的年龄、术前总胆红素、术前白蛋白、手术时间、术中出血量、胃肠吻合口瘘对术后出血的影响差异均有统计学意义(P<0.05)。经多因素logistic回归分析显示,年龄、术前总胆红素、手术时间、术中出血量、胃肠吻合口瘘是PD术后出血的独立危险因素(P<0.05);术前白蛋白是PD术后出血的保护因素(P<0.05)。结论针对影响PD术后出血因素,术前积极稳定肝肾功能,术后密切观察及护理降低并发症发生率,减少术后出血,以提高临床疗效。

Objective To explore the influencing factors and nursing measures on postoperative hemorrhage of pancreaticoduodenectomy(PD).Methods To retrospectively analyzed the clinical data of 205 patients with PD in our hospital from October 2015 to September 2018.The situation of postoperative bleeding was observed.Multivariate logistic regression was used to analyze the independent risk factors of postoperative bleeding after undergoing PD.Results In the 205 cases of patients,43 cases had postoperative bleeding and 162 cases had no postoperative bleeding.The gender,method of pancreatic jejunal anastomosis,history of chronic medical,postoperative draining fluid volume,abdominal infection,pancreatic fistula,biliary fistula,acute renal failure,gastric retention had no statistically significant effect on postoperative bleeding(P>0.05).The difference in the effect of postoperative bleeding from the age,preoperative total bilirubin,preoperative albumin,operative time,intraoperative bleeding volume,and gastrointestinal anastomotic leakage of postoperative bleeding group was all statistically significant(P<0.05).Multivariate logistic regression analysis showed that the age,preoperative total bilirubin,operative time,intraoperative bleeding volume,and gastrointestinal anastomotic leakage were independent risk factors for postoperative bleeding of PD(P<0.05).Preoperative albumin was a protective factor for postoperative bleeding in PD(P<0.05).Conclusion Againsting influence factors of the bleeding after PD,the liver and kidney function were actively stabilized before operation.Close observation and nursing could reduce the incidence of complications and reduce postoperative bleeding to improve clinical efficacy.