急诊结直肠手术后并发症危险因素分析

OPERATIVE RISK FACTORS FOR OPERATIVE COMLICATIONS IN PATIENTS WITH EMERGENCY RESECTION OF THE COLON AND RECTUM

目的 :本文评价急诊结直肠手术后的感染并发症发生的危险因素。方法 :对 1982年～ 2 0 0 2年 2 84例急诊结直肠手术病人进行回顾性研究。分别将手术后发生切口感染、腹腔感染、吻合口漏的病人分为发生组与未发生组 ,选择 13个可能影响手术预后的因素 ,进行统计分析。评价可能影响预后的危险因素。结果 :2 84例病例中切口腹腔感染 39例 (13.7% ) ,吻合漏 2 4例 (8.4 % ) ,腹腔感染 2 7例 (9.5 % ) ,7例死亡 ,死亡率2 .4 6 %。影响手术切口感染的危险因素为糖尿病 (OR =1.4 2 )、手术部位 (OR =2 .0 8)。影响吻合口愈合的危险因素为低蛋白血症 (OR =6 .2 )、腹腔严重污染 (OR =2 .5 ) ,影响腹腔感染的危险因素为腹腔严重污染 (OR=1.97)、糖尿病 (OR =1.36 )。结论 :手术部位、糖尿病是影响急诊结直肠手术切口感染的主要危险因素 ;低蛋白血症、腹腔严重污染是影响吻合口愈合的危险因素 ;腹腔严重污染、糖尿病是影响腹腔感染的危险因素。

Objective:To explore the risk factors for surgical complications in patients undergoing emergent operation of the colon and rectum.Methods: We reviewed 284 patients undergoing emergent operation of the colon and rectum from 1982 to 2002 .Based on different complications, the patients were divided into complication group and noncomplication group respectively. Thirteen factors that may influence the incidence of complication were selected. A multi-variate analysis was performed to identify the risk factors for operation complications. Results:The occurrence of incisional infection was 39 in 284 cases (13.7%),the occurrence of anastomotic leakage was 24 in 284 cases (8.4%) ,and the occurrence of abdominal cavity infection was 27 in 284 cases(9.5%).The risk factors of incision infection included diabetes mellitus(OR=1.42),region of operation(OR=2.08). The risk factors of anastomotic leakage included hypoproteinemia (OR=6.2), severe abdominal contamination (OR=2.5) .The risk factors of abdominal infection included severe abdominal contamination(OR=1.97), diabetes mellitus (OR=1.36).Conclusion:Diabetes mellitus,the region of operation are the risk factors of the incision infection; hypoproteinemia severe abdominal contamination are the risk factors of anastomsis leakage; the severe abdominal contamination, diabetes mellitus are the risk factors of abdominal infection.