腹部手术后形成粘连性肠梗阻手术指征的影响因素研究

Study on the influencing factors of operative indication of adhesive ileus after abdominal operation

目的探讨腹部手术后形成粘连性肠梗阻手术指征的影响因素。方法回顾性分析2020年6月至2022年12月深圳市龙华区人民医院收治的105例腹部手术后出现粘连性肠梗阻患者的临床资料,根据是否行粘连性肠梗阻手术分为手术组(30例)和非手术组(75例)。比较两组患者临床指标(肠粘连史、是否有腹痛加重或不缓解、是否有严重腹胀、是否发热、是否触及肿大肠襻、是否合并腹膜炎、是否有肠鸣音减弱、是否有腹腔积液及是否贫血)及炎症因子[白细胞计数(WBC)、超敏C反应蛋白(hs-CRP)]水平,分析影响腹部手术后形成粘连性肠梗阻手术指征的独立危险因素。结果手术组患者有肠道粘连史、有腹痛加重或不缓解、触及肿大肠襻、合并腹膜炎、有肠鸣音减弱及有腹腔积液占比高于非手术组,且WBC、hs-CRP水平高于非手术组(P<0.05)。多因素Logistic回归分析显示,有肠粘连史、合并腹膜炎、有腹腔积液及WBC、hs-CRP水平升高是行粘连性肠梗阻手术的独立危险因素(P<0.05)。结论肠粘连史、有腹膜炎、有腹腔积液及WBC、hs-CRP水平升高为腹腔术后粘连性肠梗阻患者手术指征的独立危险因素,临床应加强患者病史评估及炎症指标的监测,尽早明确粘连性肠梗阻患者是否需要进行手术。

Objective To investigate the influencing factors of operative indication of adhesive ileus after abdominal operation.Methods The clinical data of 105 patients with adhesive ileus after abdominal operation admitted to Longhua District People’s Hospital of Shenzhen from June 2020 to December 2022 were retrospectively analyzed.They were divided into operation group(30 cases)and non-operation group(75 cases)according to whether adhesive ileus surgery was performed.The clinical indicators(history of intestinal adhesion,symptoms of increased or no relief of abdominal pain,severe abdominal distension,fever,ability to reach swollen intestinal lapses,concomitant peritonitis,reduced bowel sound,abdominal effusion and anemia)and the levels of inflammatory factors[white blood cell count(WBC),hypersensitive C-reactive protein(hs-CRP)]were compared.To analyze the independent risk factors affecting the operative indication of adhesive ileus after abdominal surgery.Results The patients in the operation group with history of intestinal adhesion,aggravation of abdominal pain worsens or does not relieve,palpable swollen intestinal lapses,complicated peritonitis,reduced intestinal sounds and abdominal effusion were higher than those in the non-operation group,and the levels of WBC and hs-CRP were higher than those in the non-operation group(P<0.05).Multiple Logistic regression analysis showed that history of intestinal adhesion,peritonitis,abdominal effusion,and elevated WBC and hs-CRP levels were independent risk factors for operation of adhesive ileus(P<0.05).Conclusion History of intestinal adhesion,peritonitis,abdominal effusion,elevated WBC and hs-CRP levels are independent risk factors for determining surgical indications in patients with postoperative adhesive ileus.Clinical evaluation of patient history and monitoring of inflammatory indicators should be strengthened to determine whether patients with adhesive ileus should undergo surgery as soon as possible.