紧急剖宫产并发急性假性结肠梗阻的临床特点及影响因素分析

Clinical characteristics and influencing factors of acute colonic pseudo⁃obstruction after emergency cesarean section

目的探究紧急剖宫产并发急性假性结肠梗阻(ACPO)的临床特点及影响因素。方法回顾性选取2019年1月至2023年6月在河北省儿童医院妇产科行紧急剖宫产术后发生ACPO的22名产妇纳入ACPO组,同时按照与ACPO组产妇为5∶1的比例选取同期在本院行紧急剖宫产术后无ACPO的110名产妇纳入无ACPO组。观察ACPO组产妇临床特点,并收集、比较2组产妇临床相关资料,采用多因素logistic回归法分析影响产妇术后发生ACPO的危险因素。结果紧急剖宫产后并发ACPO的产妇临床均见进行性腹部隐痛,伴不同程度的恶心呕吐、腹胀、停止排便排气或少量排便排气;体格检查可见腹部隆起,以上腹、右腹较为明显,有轻度压痛、无反跳痛。单因素分析结果显示,2组产妇年龄、孕周、妊娠胎数、孕次、产次、产前体重指数(BMI)、紧急剖宫产原因、妊娠合并症占比、行全身麻醉占比、术前白蛋白水平、术后镇痛占比比较差异无统计学意义(P>0.05),ACPO组手术时间≥60 min占比、出血量≥800 ml占比、有腹部手术史占比、合并慢性盆腔炎占比、术中剥除子宫肌瘤占比均高于无ACPO组(P<0.05)。多因素logistic回归分析结果显示,手术时间≥60 min(OR=5.761)、合并慢性盆腔炎(OR=3.241)、术中剥除子宫肌瘤(OR=4.319)是紧急剖宫产产妇术后并发ACPO的危险因素(P<0.05)。结论手术时间≥60 min、合并慢性盆腔炎、术中剥除子宫肌瘤是紧急剖宫产产妇术后并发ACPO的危险因素。因此,临床对于上述行紧急剖宫产的产妇术后需予以高度关注,提前采取措施进行防治,以有效降低术后ACPO的发生风险。

Objective To explore the clinical characteristics and influencing factors of acute colonic pseudo‑obstruction(ACPO)after emergency cesarean section.Methods A total of 22 parturients with ACPO after emergency cesarean section who were admitted to Hebei Children’s Hospital from January 2019 to June 2023 were retrospectively selected and assigned to the ACPO group,and 110 parturients without ACPO after emergency cesarean section during the same period were selected as the non‑ACPO group,according the ratio of 5∶1.The clinical characteristics of the ACPO group were observed.The clinical data of the two groups were collected and compared.Multivariate logistic regression methods were used to analyze the risk factors of ACPO after emergency cesarean section.Results All the patients with ACPO after emergency cesarean section presented with progressive abdominal dull pain,nausea and vomiting,abdominal distension,cessation of defecation and exhaust or a small amount of defecation and exhaust.Physical examination showed abdominal bulge,especially in the upper and right abdomen,with mild tenderness and with no rebounding pain.Univariate analysis showed that there were no significant differences in the maternal age,gestational weeks,embryo number,gravidity,parity,prenatal body mass index(BMI),cause of emergency cesarean section,pregnant complications,general anesthesia,preoperative albumin level or postoperative analgesia between the two groups(all P>0.05);the proportions of operation time≥60 min,blood loss≥800 ml,history of abdominal surgery,cocurrent chronic pelvic inflammatory disease,and intraoperative removal of uterine fibroids in the ACPO group were significantly higher than those in the non‑ACPO group(all P<0.05).Multivariate logistic regression analysis showed that operation time≥60 min(OR=5.761),concurrent chronic pelvic inflammatory disease(OR=3.241),and intraoperative removal of uterine fibroids(OR=4.319)were the risk factors of ACPO after emergency cesarean section(all P<0.05).Conclusion Operation time≥60 min,concurrent chronic pelvic inflammatory disease,and intraoperative removal of uterine fibroids are the risk factors of ACPO after emergency cesarean section.More attention should be paid to the parturients with the above‑mentioned risk factors after emergency cesarean section,and preventive measures should be taken in advance to effectively reduce the risk of postoperative ACPO.