压疮患者皮瓣修复术后疗效不佳的影响因素

Influence factors of poor efficacy after flap repair operation in patients with pressure ulcers

目的探讨压疮患者皮瓣修复术后疗效不佳的影响因素。方法采用回顾性病例系列研究方法。2011年1月—2021年6月, 海南省人民医院收治符合入选标准的125例行皮瓣修复手术的Ⅲ、Ⅳ期压疮患者, 其中男82例、女43例, 年龄15~90(57±20)岁。根据术后疗效, 将患者分为疗效不佳组(47例)、疗效佳组(78例)。统计2组患者年龄、性别, 压疮发生的部位、分期、面积、骨外露情况, 术前创面分泌物标本微生物培养情况, 合并骨髓炎、糖尿病、下肢阵发性肌痉挛及大小便失禁情况, 手术清创联合负压伤口疗法次数, 皮瓣类型, 术后卧位情况, 术前白蛋白、白细胞、C反应蛋白(CRP)及血红蛋白等临床资料。对数据行独立样本t检验、Mann-WhitneyU检验、χ^(2)检验。行二分类多因素logistic回归分析, 筛选影响125例Ⅲ、Ⅳ期压疮患者皮瓣修复术后疗效不佳的独立危险因素。结果疗效不佳组患者发生下肢阵发性肌痉挛的比例为22/47, 明显高于疗效佳组的3/78, χ^(2)=33.83, P<0.01;疗效不佳组患者术前血红蛋白水平为(102±17)g/L, 明显低于疗效佳组的(113±20)g/L(t=-3.24, P<0.01);疗效不佳组患者术前CRP水平为39.1(14.1, 91.6)mg/L, 明显高于疗效佳组的15.3(6.6, 42.0)mg/L(Z=-3.04, P<0.01);2组患者其余指标比较, 差异均无统计学意义(P>0.05)。多因素logistic回归分析显示, 年龄、下肢阵发性肌痉挛、术前血红蛋白是压疮患者皮瓣修复术后疗效不佳的独立危险因素(比值比分别为1.03、40.69、0.97, 95%置信区间分别为1.00~1.06、9.18~180.39、0.95~1.00, P<0.05或P<0.01)。结论多种因素会导致压疮患者皮瓣修复手术后疗效不佳, 其中年龄、下肢阵发性肌痉挛、术前血红蛋白水平是独立危险因素。

Objective To investigate the influence factors of poor efficacy after flap repair operation in patients with pressure ulcers.Methods The retrospective case series study was conducted.From January 2011 to June 2021,125 patients with stageⅢandⅣpressure ulcers treated in Hainan General Hospital met the inclusion criteria.There were 82 males and 43 females,aged 15-90(57±20)years.According to the postoperative effects,the patients were divided into poor efficacy group(47 cases)and good efficacy group(78 cases).The clinical data of patients in the two groups were collected,including the age,gender,location,stage,size,and bone exposure of pressure ulcers,preoperative microorganism culture results of wound exudate sample,whether combined with osteomyelitis,diabetes,lower limb paroxysmal myospasm,and gatism or not,the number of surgical debridement combined with negative-pressure wound therapy,type of surgical flap,postoperative position,and preoperative albumin,leukocyte,C-reactive protein(CRP),and hemoglobin.Data were statistically analyzed with independent sample t test,Mann-Whitney U test,and chi-square test.The binary multivariate logistic regression analysis was conducted to screen the independent risk factors influencing the poor efficacy after flap repair operation in 125 patients with stageⅢandⅣpressure ulcers.Results The ratio of patients with lower limb paroxysmal myospasm in poor efficacy group was 22/47,which was significantly higher than 3/78 in good efficacy group(χ^(2)=33.83,P<0.01).The preoperative hemoglobin level of patients in poor efficacy group was(102±17)g/L,which was significantly lower than(113±20)g/L in good efficacy group(t=-3.24,P<0.01).The preoperative CRP level of patients was 39.1(14.1,91.6)mg/L in poor efficacy group,which was significantly higher than 15.3(6.6,42.0)mg/L in good efficacy group(Z=-3.04,P<0.01).There were no statistically significant differences in other indexes between patients in the two groups(P>0.05).Multivariate logistic regression analysis showed that age,lower limb paroxysmal myospasm,and preoperative hemoglobin level were the independent risk factors for poor efficacy after flap repair operation in patients with pressure ulcers(with odds ratios of 1.03,40.69,and 0.97,95%confidence intervals of 1.00-1.06,9.18-180.39,and 0.95-1.00,respectively,P<0.05 or P<0.01).Conclusions Poor efficacy after flap repair operation in patients with pressure ulcers is affected by many factors,among which the age,lower limb paroxysmal myospasm,and preoperative hemoglobin level are the independent risk factors.