胰十二指肠切除术并发胰漏高危因素分析及护理对策  

Analysis of High Risks of Postoperative Pancreatic Leakage in Patients undergoing Pancreatoduodenectomy and its Nursing Care

作　　者：王若乔[1] 付立[2] 李丽[3] 田莉莉[1] 叶志霞[2] 

机构地区：[1]第二军医大学东方肝胆外科医院研究生队,上海200438 [2]第二军医大学东方肝胆外科医院护理部 [3]第二军医大学东方肝胆外科医院监护室

出　　处：《解放军护理杂志》2008年第23期11-13,16,共4页Nursing Journal of Chinese People's Liberation Army

摘　　要：目的探讨恶性梗阻性黄疸患者行胰十二指肠切除术术后胰漏的高危因素及护理对策。方法回顾性研究300例患者的一般资料、实验室检查结果、术中情况及术后并发症发生情况,应用SPSS13.0软件包对上述临床资料进行Logistic回归分析,并对结果采用Fisher’s判别分析。结果37例(占12.3%)患者术后发生胰漏。Lo-gistic回归得到影响该类患者术后发生胰漏的高危因素包括:性别(男性),术前行ERCP检查及治疗,既往心脏病史,手术方式(胰十二指肠切除术+扩大淋巴结清扫术),病理分化(低),尿素氮变化率[(术后第1天浓度-术前浓度)/术前浓度]增大。通过Fisher’s判别分析得到3个判别函数。结论通过判别方程预见患者术后发生胰漏的危险性,制定针对性的预见性护理方案,以降低患者术后胰漏的发生率及病死率,减少住院天数和费用,促进患者康复。Objective To explore the high risk factors of postoperative pancreatic leakage in malignant obstructive jaundice patients undergoing panreatoduodenectomy. Methods Demographic data,laboratory results,patient＇s condition during operation,and postoperative complications of 300 patients were obtained by retrospective study and logistic regression analysis and Fisher＇s discriminant analysis were conducted by SPSS 13.0 software. Results Postoperative pancreatic leakage occurred in 37 patients. Results of logistic regression analysis showed that gender（male）,preoperative ERCP examination and treatement,previous heart disease histroy, operation approach （panreatoduodenectomy plus extended lymoh node dissection）, tumor differentiation degree （low）, urea nitrogen change ratio （high） were high risk factors of pancreatic leakage.-Three discriminant function were got by Fisher＇s discriminant analysis. Conclusion High risk factors of postoperative pancreatic leakage can be predicted according to discriminant formula and corresponding predictive nursing care plan can be developed so that its incidence and mortality rate, hospitalization days and cost could be reduced, and patient＇s recovery improved.

关 键 词：梗阻性黄疸 胰十二指肠切除术 胰漏 高危因素 

分 类 号：R473.6[医药卫生—护理学]