胃镜下食管胃静脉曲张栓塞术后患者发热的影响因素分析

Influencing factors of fever after esophagogastric varices embolization under gastroscope

目的分析胃镜下食管胃静脉曲张栓塞术后患者发热的影响因素。方法选取2019年1至12月浙江大学医学院附属金华医院收治的行胃镜下食管胃静脉曲张栓塞术的肝硬化患者204例。患者术后48 h内出现1次及以上耳温≥37.5℃为术后发热,分析患者术后发热的影响因素。结果术后发热患者与未发热患者术前静脉曲张程度、肝癌史、手术时胃腔清洁程度、术前糖化血红蛋白水平、手术时间、术中组织胶用量比较差异均无统计学意义(均P>0.05),而性别、年龄、糖尿病史、肝功能分级、术前WBC、术前中性粒细胞比较差异均有统计学意义(均P<0.05)。多因素分析显示,患者术前合并糖尿病(OR=4.653,95%CI:1.391~15.571)、肝功能差(肝功能B级、C级分别OR=5.127、36.438,95%CI:1.275~20.618、4.887~271.692)是术后发热的独立危险因素(均P<0.05)。结论合并糖尿病、肝功能差的肝硬化患者行胃镜下食管胃静脉曲张栓塞术后容易出现发热,故术前应采取有效措施积极控制血糖,改善肝功能以预防患者术后发热。

Objective To analyze the influencing factors of fever after esophagogastric varices embolization under gastroscopy.Methods A total of 204 patients with cirrhosis who underwent esophagogastric varices embolization under gastroscopy in Jinhua Hospital,Zhejiang University School of Medicine from January to December 2019 were enrolled.Postoperative fever was defined as one or more times of ear temperature≥37.5℃within 48 h after surgery.The influencing factors of postoperative fever were analyzed.Results There were no significant differences in the degree of varicose veins,history of liver cancer,cleaning degree of gastric cavity,level of glycosylated hemoglobin before surgery,operation time and dosage of tissue glue between patients with fever and those without fever(all P>0.05).There were significant differences in gender,age,diabetes history,grade of liver function,preoperative WBC and preoperative neutrophil between two groups(all P<0.05).Multivariate analysis showed that the comorbid diabetes mellitus(OR=4.653,95%CI:1.391-15.571)and poor liver function(OR=5.127 and 36.438,95%CI:1.275-20.618 and 4.887-271.692;for grade B and grade C liver function respectively)were independent risk factors for postoperative fever(all P<0.05).Conclusion Comorbid diabetes and poor liver function are independent risk factors for fever after esophagogastric variceal embolization under gastroscopy,therefore,effective measures should be taken to control blood glucose and improve liver function to prevent postoperative fever.