腹盆腔及消化道非计划再手术营养相关危险因素的研究

Analysis of the nutrition-related risk factors in unplanned reoperation related to abdominal and pelvic cavity and digestive tract

目的基于控制营养状况评分探索腹盆腔及消化道非计划再手术发生的营养相关危险因素。方法根据纳入排除标准,确定2020年1月至2021年12月在山东省第一医科大学附属肿瘤医院住院期间发生两次手术,且具有评估所需全部数据的87例患者为病例组,以年龄、性别、手术级别1∶1配对组成对照组,进行回顾性病例对照研究。单因素分析采用配对χ^(2)或t检验,多因素分析采用条件Logistic回归。结果山东第一医科大学附属肿瘤医院2020年1月至2021年12月择期非计划再手术发生率为0.68%。单因素分析显示,术前控制营养状况(CONUT)评分≥4分、术前贫血、术前低白蛋白血症、术前1个月体重减少≥2 kg、手术持续时间≥5 h、术中出血量≥250 ml组非计划再手术的比例均明显高于对照组,且差异具有统计学意义(P<0.05);条件Logistic回归分析显示术前CONUT评分≥4分、术中出血量≥250 ml及术前1个月体重减少≥2 kg是非计划再手术发生的独立危险因素(P<0.05)。结论术前免疫营养状况不良是腹盆腔及消化道非计划再手术发生的独立危险因素,通过纠正患者术前的免疫营养状况可降低腹盆腔及消化道非计划再手术的发生风险并改善其预后。

Objective To explore risk factors of unplanned reoperations in patients with malignant tumors of abdominal pelvic cavity and digestive tract based on controlled nutritional status score.Method The clinical data of patients underwent unplanned reoperation who treated in Medical Administration of the Affiliated Cancer Hospital of Shandong First Medical University from January 2020 to December 2021 were retrospectively collected and each operation was matched in a ratio of 1∶1 as a case-control study object.Univariate analysis was done byχ^(2) or t test and multivariate analysis was performed by conditional logistic regression.Result The incidence of unplanned reoperation in our hospital from 2020 to 2021 was 0.68%.The results of Univariate analysis showed that COUNT≥4 anemia and hypo-albuminemia before operation weight loss≥2 kg in 1 month before operation operation duration≥5 h blood loss≥250 ml during surgery were risk factors P<0.05.Conditional logistic regression multivariate analysis showed that CONUT score blood loss≥250 ml during surgery and weight loss≥2 kg in 1 month before operation were independent risk factors for unplanned reoperation.Conclusion Poor immunonutrition status before operation is a independent risk factor for unplanned reoperation of abdominal pelvic and gastrointestinal tract.Effective intervention on independent risk factors can reduce incidence of unplanned reoperation in future and improve prognosis.