老年肠梗阻病人的临床特征分析

Clinical characteristics of intestinal obstruction in elderly patients

目的分析年龄是否为肠梗阻病人手术预后不良的独立危险因素,并探讨老年肠梗阻病人最佳的治疗方式。方法回顾性分析2016年5月至2017年5月在我院住院治疗被诊断为肠梗阻的病人326例,收集其临床特征与结局情况。结果 326例肠梗阻病人中,手术治疗244例,非手术治疗82例;根据年龄分为A组(n=167,<60岁)、B组(n=69,60~69岁)、C组(n=50,70~79岁)、D组(n=40,≥80岁)。手术组死亡率、发生再次梗阻率明显低于非手术组,差异有统计学意义(P <0. 05);手术组与非手术组并发症发生率差异无统计学意义(P>0. 05)。各年龄组间死亡率、术后并发症发生率、住院天数、住院费用差异均无统计学意义(P> 0. 05);各年龄组间发生再梗阻及再次入院发生率差异有统计学意义(P <0. 05)。多因素Logistic回归分析结果显示,合并COPD(OR=8. 28,95%CI:1. 29~53. 15,P=0. 026)是肠梗阻病人死亡的独立危险因素,手术(OR=0. 12,95%CI:0. 02~0. 78,P=0. 026)是肠梗阻病人死亡的独立保护因素;血清白蛋白水平(OR=2. 79,95%CI:1. 78~4. 39,P <0. 01)是肠梗阻病人出现并发症的独立预测因素,手术治疗(OR=0. 27,95%CI:0. 14~0. 56,P <0. 01)是发生再梗阻的独立保护因素。结论对于肠梗阻病人,不应将年龄作为其选择手术治疗的限制因素,老年病人应根据情况更为积极地行手术治疗。

Objective To analyze whether age is an independent risk factor for poor prognosis of the patients with intestinal obstruction,and to explore the prime therapy method for elderly patients with intestinal obstruction. Methods The data of 326 patients who were diagnosed as intestinal obstruction from May 2016 to May 2017 in our hospital were collected. Results The patients were divided into four groups according to age:group A(n=167)were younger than 60 years old,group B(n=69)were between 60 and 69 years old,groups C(n=50)were between 70 and 79 years old,and group D(n=40)were older than 80 years old;Among these patients,244 cases received operation therapy and 82 cases received non-operation therapy. Compared with the patients experiencing non-operation therapy,the patients receiving surgery had lower rates of mortality and recurrence(P < 0. 05). There was no difference in complications between different therapy(P > 0. 05). There was no difference in the mortality,postoperative complications,average hospital stay and hospitalization expenses among different age groups(P > 0. 05),but the differences in the recurrence and readmission rates were statistically significant(P < 0. 05). Multi-factor Logistic regression analysis showed that chronic obstructive pulmonary disease(OR=8. 28,95%CI:1. 29-53. 15,P=0. 026)was an independent risk factor for the mortality of patients with intestinal obstruction,but surgery(OR=0. 12,95%CI:0. 02-0. 78,P=0. 026) was an independent protective factor. The serum albumin level(OR=2. 79, 95%CI:1. 78-4. 39,P < 0. 01)was an independent predictor of intestinal obstruction complications,and surgery(OR=0. 27,95%CI:0. 14-0. 56,P < 0. 01)was an independent protective factor of reoccurrence. Conclusions Age should not be considered as a limiting factor for the patients with intestinal obstruction in choice of operation therapy. Contrarily,operation therapy should be adopted aggressively for elderly patients with intestinal obstruction.