紧急剖宫产术后发生急性结肠假性梗阻的危险因素分析

Analysis of risk factors for acute colonic pseudo-obstruction after Emergency Cesarean section

目的探讨紧急剖宫产术后发生急性结肠假性梗阻(ACPO)的危险因素。方法将河南省人民医院2018-07—2020-07行紧急剖宫产术后诊断ACPO的33例产妇为ACPO组,按照与ACPO组5∶1比例选择同期行剖宫产术后未发生ACPO的165例产妇为对照组。比较2组产妇术前及术后化验指标、术中情况,以及危险因素。采用t检验,χ^(2)检验及Logistic回归分析进行统计学分析。结果ACPO组术后白细胞计数高于对照组,血钾浓度低于对照组,差异均有统计学意义(P<0.05)。单因素分析结果显示,术中出血量>1000 mL、手术时间>1 h、术中剥除子宫肌瘤、应用切口护皮圈比例,以及术后体温>38℃、活动时间>12 h,与ACPO的发生有关(P<0.05)。Logistic回归分析显示,手术时间>1 h、术中剥除子宫肌瘤、术后体温>38℃,为紧急剖宫产术后ACPO发生的危险因素:分别为1.579、1.281、1.318;OR(95%CI)分别为4.941(1.948~12.530)、3.599(1.316~9.844)、3.736(1.234~11.312),P<0.05。结论手术时间>1 h、术中剥除子宫肌瘤、术后体温>38℃,是紧急剖宫产术后产妇发生ACPO的危险因素。

Objective To evaluate the risk factors of acute colonic pseudo-obstruction(ACPO)after emergency cesarean section.Methods Totally 33 patients who underwent emergency cesarean section from July 2018 to July 2020 were selected as the ACPO group,and 165 patients who did not have ACPO after cesarean section were selected as the control group,according to the ration of 5∶1,and the preoperative and postoperative indexes,intraoperative conditions and risk factors were compared between the two groups,t test,χ^(2) test and Logistic regression were used for statistical analysis.Results The WBC count and serum potassium concentration in ACPO group were significantly higher than those of the control group(P<0.05).Univariate analysis showed that more than 1000mL of blood loos,more than 1 hour of opration time,the proportion of uterinemyoma removed and skin-protecting incision used,more than 38℃of the body temperature,more than 12h of activity time were related to the occurrence of ACPO(P<0.05).Logistic regression analysis showed that more than 1 hour of operation time,the proportion of uterinemyoma removed,more than 38℃of the body temperature were risk factors of ACPO after emergency cesarean section:was 1.579、1.281、1.318,OR(95%CI)was 4.941(1.948~12.530)、3.599(1.316~9.844)、3.736(1.234~11.312),P<0.05.Conclusion More than 1 hour of the operation time,the proportion of uterine myoma removed,more than 38℃of the body temperature were risk factors of ACPO after Emergency Cesarean section.