236例血液病脾切除术围手术期并发症危险因素分析

Risk factors for perioperative complications in 236 cases with hematologic diseases undergoing splenectomy

目的:分析脾切除术治疗血液系统疾病围手术期并发症的危险因素。方法:2000-2017年我院236例血液病患者行脾切除术治疗,单因素及多因素二项Logistic回归分析术前疾病特征与术后并发症的关系。结果:236例患者中,免疫性血小板减少症(ITP)139例,遗传性球形红细胞增多症(HS)64例,自身免疫性溶血性贫血(AIHA)包括Evans综合征12例,淋巴瘤/T-大颗粒淋巴细胞白血病15例,脾大原因未明6例。HS患者术后感染发生率最低(10.9%),显著低于ITP患者(25.5%,P=0.018),ITP患者术后感染发生率与AIHA患者(25.0%)、淋巴瘤患者(33.3%)相当。这4种疾病术后切口延迟愈合发生率差异无统计学意义。低白蛋白血症患者术后感染发生率显著高于正常水平患者(53.9%vs 20.9%,P=0.016),术后切口延迟愈合发生率高于正常水平患者(46.2%vs 19.8%,P=0.057)。低球蛋白血症患者术后感染发生率及切口延迟愈合发生率与正常水平患者比较,差异均无统计学意义(16.7%vs 24.5%,P=0.253;25.0%vs 21.8%,P=0.642)。术前曾长期应用糖皮质激素治疗患者术后感染发生率显著高于未长期应用患者(26.3%vs 10.3%,P=0.012),但切口延迟愈合发生率在2组间差异无统计学意义(20.3%vs 24.1%,P=0.540)。术前曾患呼吸系统感染患者术后呼吸系统感染发生率显著高于术前未患感染者(38.7%vs 17.7%,P=0.007)。多因素Logistic回归分析显示,术后感染的危险因素为年龄、长期应用糖皮质激素、曾有呼吸系统感染(P<0.05);术后切口延迟愈合的危险因素只有年龄(P<0.05)。结论:年龄、长期应用糖皮质激素、曾有呼吸系统感染是脾切除术治疗血液系统疾病围手术期并发症的危险因素。

Objective:To analyze risk factors for perioperative complications of splenectomy for hematological diseases.Method:The relationship between preoperative clinical features and postoperative complications of patients with hematological diseases undergoing splenectomy in our hospital from 2000 to 2017 was analyzed using single factor analysis and polytomous binomial regression analysis.Result:Of the 236 patients,there were 139 cases with immunothrombocytopenia(ITP),64 cases with hereditary spherocytosis(HS),12 cases with autoimmune hemolytic anemia(AIHA),15 cases with lymphoma/T-granular lymphocytic leukemia,and 6 cases with unknown etiology in splenomegaly.HS patients had the lowest occurrence of postoperative infection(10.9%),which was significantly lower than that in ITP patients(25.5%,P=0.018).The risks in AIHA(25.0%) and lymphoma(33.3%) were similiar to ITP.The occurrence of delayed wound healing between four diseases was not significantly different.The occurrence of postoperative infection in patients with hypoalbuminemia was significantly higher than that in patients with normal level(53.9% vs 20.9%,P=0.016),but the occurrence of delayed wound healing was not significantly different between the two groups(46.2% vs 19.8%,P=0.057).The occurrence of postoperative infection and delayed wound healing in patients with hypoglobulinemia were not significantly different from those without hypoglobulinemia(16.7% vs 24.5%,P=0.253;25.0% vs 21.8%,P=0.642).The occurrence of postoperative infection in patients who had been treated with glucocorticoid for a long time before operation was significantly higher than that in patients who didn’t accept that treatment(26.3% vs 10.3%,P=0.012).But the occurrence of delayed wound healing between the two groups was not significantly different(20.3% vs 24.1%,P=0.540).The occurrence of postoperative respiratory infection in patients with previous respiratory infection before operation was significantly higher than that in patients without preoperative infection(38.7% vs 17.7%,P=0.007).Multivariate Logistic regression analysis showed that the risk factors of postoperative infection were age,long-term use of glucocorticoids,previous respiratory infection(P<0.05),but age was the only risk factor for delayed wound healing(P<0.05).Conclusion:Age,long-term use of glucocorticoid and previous respiratory infection are risk factors for perioperative complications of splenectomy for hematological diseases.