老年肛周脓肿病人发生坏死性筋膜炎的危险因素分析

Analysis of risk factors for necrotizing fasciitis in elderly patients with perianal abscess

目的探讨老年肛周脓肿病人发生坏死性筋膜炎(PNF)的危险因素,以指导临床治疗。方法回顾性分析南京市中医院2019年7月至2020年6月收治的老年重度肛周脓肿病例122例,按是否发生坏死性筋膜炎分为PNF组(59例)和非PNF组(63例),比较2组性别、体质量、基础疾病、入院时血白蛋白水平等情况,采用多因素Logistic回归分析筛选发生PNF的危险因素。结果相较于非PNF组,PNF组中糖尿病病人更多、术前白蛋白水平更低、发病前基础血糖更高(P<0.05)。多因素分析显示,糖尿病病史(OR=5.695,95%CI1.389~20.042,P<0.05)、基础高血糖(OR=2.362,95%CI1.047~6.548,P<0.05)是老年肛周脓肿病人发生PNF的独立危险因素。结论有糖尿病病史、基础高血糖的老年肛周脓肿病人易发生PNF。

Objective To investigate the risk factors of perianal necrotizing fasciitis in the elderly patients with perianal abscess,in order to guide clinical treatment.Methods The study reviewed 122 cases of severe perianal abscess admitted to Nanjing Hospital of Chinese Medicine from July 2019 to June 2020.The patients were divided into necrotizing fasciitis group(59 cases)and non-necrotizing fasciitis group(63 cases)according to the occurrence of necrotizing fasciitis.The gender,weight,basic diseases,serum albumin levels at admission were recorded and compared between the two groups.Multivariate Logistic regression analysis was performed to investigate the risk factors of perianal necrotizing fascitis.Results Compared with non-necrotizing fasciitis group,necrotizing fasciitis group had higher incidence rate of diabetes,lower level of serum albumin at admission,and higher level of basal blood glucose(P<0.05).Multivariate Logistic regression analysis showed that history of diabetes(OR=5.695,95%CI 1.389-20.042,P<0.05)and basal hyperglycemia(OR=2.362,95%CI 1.047-6.548,P<0.05)were the independent risk factors of perianal necrotic fasciitis.Conclusions The elderly patients with perianal abscess with a history of diabetes or basic hyperglycemia are prone to presenting with perianal necrotizing fasciitis.