剖宫产术后并发肠梗阻的相关因素研究

Study on the related factors of intestinal obstruction after cesarean section

目的分析剖宫产术后并发肠梗阻的相关因素。方法以2009年4月至2019年4月在首都医科大学附属北京妇产医院住院行剖宫产术分娩并发术后肠梗阻的500例患者为病例组,以与病例组同一日行剖宫产术的术后未发生肠梗阻的500例患者为对照组。收集患者一般情况、孕期合并症、血常规及生化指标、与手术相关因素等资料,比较肠梗阻患者和非肠梗阻患者间差异。采用多因素logistic回归模型分析剖宫产术后肠梗阻的相关影响因素。结果500例剖宫产术后肠梗阻患者的年龄为(33.3±4.2)岁,500例剖宫产术后未发生肠梗阻患者的年龄为(31.6±3.9)岁。肠梗阻患者孕期合并症的发生率均高于非肠梗阻患者(均P<0.05)。多因素分析显示,患者术前贫血[OR值(95%CI)为5.318(1.522~18.580),P=0.009]、术后低蛋白[OR值(95%CI)为0.376(0.143~0.993),P=0.048]、术中出血量≥500 ml[OR值(95%CI)为3.085(1.551~6.136),P=0.001]、术中粘连[OR值(95%CI)为2.856(1.285~6.347),P=0.010]是剖宫产术后肠梗阻发生的危险因素,术中应用防粘连药物[OR值(95%CI)为0.322(0.158~0.654),P=0.002]为剖宫产术后肠梗阻发生的保护性因素。结论贫血及低蛋白的患者剖宫产术后发生肠梗阻的风险增加。

Objective To analyze the related factors of intestinal obstruction after cesarean section.Methods From April 2009 to April 2019,500 patients with cesarean section and postoperative intestinal obstruction in Beijing Maternity Hospital Affiliated to Capital Medical University were taken as the case group,and 500 patients without postoperative intestinal obstruction who underwent cesarean section on the same day as the case group were taken as the control group.The data of patients'general characteristics,pregnancy complications,blood routine and biochemical indexes,and operation related factors were collected to compare the differences between patients with intestinal obstruction and patients without intestinal obstruction.Multivariate logistic regression model was used to analyze the related factors of intestinal obstruction after cesarean section.Results The age of 500 patients with intestinal obstruction after cesarean section was(33.3±4.2)years,and the age of 500 patients without intestinal obstruction after cesarean section was(31.6±3.9)years.The incidence of pregnancy complications in patients with intestinal obstruction was higher than that in patients without intestinal obstruction(all P<0.05).Multivariate analysis showed that preoperative anemia[OR(95%CI)of 5.318(1.522-18.580),P=0.009],postoperative low protein[OR(95%CI)of 0.376(0.143-0.993),P=0.048],intraoperative bleeding≥500 ml[OR(95%CI)of 3.085(1.551-6.136),P=0.001],intraoperative adhesion[OR(95%CI)of 2.856(1.285-6.347),P=0.010]were the risk factor of intestinal obstruction after cesarean section.The intraoperative application of antiadhesion drugs[OR(95%CI)of 0.322(0.158-0.654),P=0.002]was the protective factor of intestinal obstruction after cesarean section.Conclusions Patients with anemia and low protein have an increased risk of intestinal obstruction after cesarean section.