恶性梗阻性黄疸经皮肝穿刺胆道引流术后院内死亡危险因素探讨  

Risk factors for in-hospital mortality in patients underwent pertaneous transhepatic biliary drainage with malignant obstructive jaundice： a prospective study

作　　者：牛洪涛[1] 王泽静[1] 翟仁友[2] 王剑锋[2] 黄强[2] 戴定可[2] 

机构地区：[1]秦皇岛市第一医院放射科,066000 [2]首都医科大学附属北京朝阳医院放射科

出　　处：《中华放射学杂志》2012年第12期1114-1118,共5页Chinese Journal of Radiology

基　　金：国家“十一五”科技支撑计划资助项目（2007BA105806）

摘　　要：目的探讨与恶性梗阻性黄疸患者经皮肝穿刺胆道引流术（PTBD）后院内死亡相关的独立的术前、术中及术后危险因素。方法因恶性梗阻性黄疸第1次行PTBD引流155例患者纳入本研究，根据术后30d内患者死亡情况分为院内死亡组和生存组，应用单因素和多因素分析对25个术前、4个术中和6个术后潜在的与院内死亡相关的危险因素进行分析，连续变量比较应用t检验，分类变量应用χ2检验；将单因素分析筛选出的可能危险因素再进行多因素Logistic分析。结果155例患者中26例于术后30d内死亡（16．8％），即院内死亡组；其余129例为生存组。单因素分析显示25个术前潜在的危险因素中9个具有统计学意义，再对其进行多因素分析显示肝功能分级C级[比值比（OR）为4．024，95％置信区间（CI）为1．432-11．307，P〈0．05]、患者生活质量评分≤30分（OR为8．688，95％CI为2．788～27．079，P〈0．05）和肌酐≥6．93μmol／L（OR为5．102，95％CI为1．798～14．478，P〈0．05）为具有统计学意义的危险因素。单冈素及多因素分析显示4个术中潜在的危险因素均无统计学意义；单因素分析显示6个术后潜在的危险因素中3个具有统计学意义，继续进行多因素分析显示PTBD术后胆道感染（OR为6．239，95％CI为2．289-16．999，P〈0．05）和引流不成功（OR为7．467，95％CI为2．481-22．475，P〈0．05）为具有统计学意义的危险因素。结论3个术前和2个术后危险因素与恶性梗阻性黄疸患者院内死亡的发生有关。Objective In-hospital mortality rate in patients undergoing percutanous transhepatic biliary drainage for malignant obstructive jaundice remained high. This study aimed to assess pre-, intra- and post-procedure risk factors which were independently associated with increased in-hospital mortality. Methods One hundred and fifty-five consecutive patients with malignant obstructive jaundice received initial PTBD drainage. Twenty-five pre-procedure, 4 intra-procedure and 6 post- procedure factors potentially related with in-hospital mortality were assessed by univariate and multivariate analysis. Results In-hospital mortality rate was 16. 8% （26/155）. Of 25 pre-proeedure variables analysed, Child-Pugh classification C, creatinine （ ≥6. 93μmol/L ） and quality of life （ ≤ 30 ） were found to be significant in univariate and muhivariate analysis. Increased mortality was seen in this study with two or more risk factors, significantly different from patients who had none or one risk factor（ P 〈 0. 01 ）. None of the intra-procedure factors were important in identifying patients at risk of death. Multivariate analysis indicated post-PTBD cholangitis and unsuccessful drainage as post-procedure risk factors that correlated with in-hospital death. Conclusions Three pre-procedure and two post-procedure risk factors were identified associated with in-hospital mortality.

关 键 词：黄疸 阻塞性 引流术 医院病死率 危险因素 

分 类 号：R735[医药卫生—肿瘤]