减重代谢术后腹腔感染发生的危险因素

Risk factors for the occurrence of intra-abdominal infections after bariatric and metabolic surgery

目的分析减重代谢术后腹腔感染(IAI)发生的危险因素。方法接受减重代谢术治疗的472例患者,术后19例发生IAI(IAI组),453例未发生IAI(非IAI组)。绘制ROC曲线评估术后CRP和降钙素原(PCT)对IAI发生的诊断效能,采用logistic回归分析减重代谢术后IAI发生的独立危险因素。结果两组手术方式、手术时间及术后第1、3天CRP和PCT比较均有统计学差异(P<0.05)。术后第3天,CRP和PCT诊断IAI发生的AUC大于术后第1天(P<0.05);取CRP最佳诊断界值为123.3 mg/L时,其诊断IAI发生的灵敏度和特异度分别为84.2%和80.8%;取PCT最佳诊断界值为0.12 ng/L时,其诊断IAI发生的灵敏度和特异度分别为73.7%和85.7%。术后第3天CRP≥123.3 mg/L和PCT≥0.12 ng/L是减重代谢术后IAI发生的独立危险因素(P<0.05)。结论术后第3天CRP≥123.3 mg/L和PCT≥0.12 ng/L是减重代谢术后IAI发生的独立危险因素。

Objective To analyze the risk factors for the occurrence of intra-abdominal infections(IAI)after bariatric and metabolic surgery.Methods The clinical data of 472 patients treated with bariatric and metabolic surgery were retrospectively analyzed.IAI occurred in 19 cases(group IAI),which did not occur in 453 cases(group non-IAI).ROC curve was drawn to evaluate the diagnostic efficacy of CRP and procalcitonin(PCT),and logistic regression was used to analyze the risk factors for IAI after bariatric and metabolic surgery.Results There were significant differences in surgical methods,operation time,CRP and PCT on the 1^(st) and 3^(rd) day after surgery between the two groups(P<0.05).The area under ROC curve of CRP and PCT on the 3^(rd) day after surgery was larger than those on the 1^(st) day after surgery(P<0.05).Taking 123.3 mg/L on the 3^(rd) day after surgery as the cut-off value of CRP,the sensitivity and specificity of diagnosing IAI were 84.2%and 80.8%,respectively.Taking 0.12 ng/L on the 3^(rd) day after surgery as the cut-off value of PCT,the sensitivity and specificity of diagnosing IAI were 73.7%and 85.7%,respectively.CRP≥123.3 mg/L and PCT≥0.12 ng/L on the 3^(rd) day after surgery were the independent risk factors for IAI after bariatric and metabolic surgery(P<0.05).Conclusion CRP≥123.3 mg/L and PCT≥0.12 ng/L on the 3^(rd) day after operation are the independent risk factors for IAI after bariatric and metabolic surgery.