腹部手术后胃瘫综合征的临床诊治及相关因素分析  

Clinical diagnosis and treatment of postsurgical gastroparesis syndrome in patients after abdominal operation

作　　者：夏博[1] 王斌[1] 赵光忠[1] 李增军[2] 

机构地区：[1]山东省临朐县人民医院普外科,山东临朐262600 [2]山东省肿瘤医院外四科,山东济南250117

出　　处：《中国医药导报》2013年第21期72-74,77,共4页China Medical Herald

基　　金：山东省医药卫生科技发展计划项目(编号2011HW069)

摘　　要：目的探讨腹部手术后胃瘫综合征(PGS)的临床诊治及相关因素。方法选择山东省临朐县人民医院1997年1月～2011年3月行腹部手术患者191例,分析并比较术后PGS在年龄、性别、手术时间、麻醉方式、是否合并基础疾病、术后低蛋白血症、术后低氧血症、术后电解质紊乱等因素间的分布情况;采用Logistic回归分析对术后PGS相关因素进行分析。结果①发生PGS的患者共17例,发生率为8.9%。②术后PGS发生率在年龄(≥70岁、<70岁)[6.1%(7/115)、13.2%(10/76)]、手术时间(≥90 min、<90 min)[14.5%(9/62)、6.2%(8/129)]、麻醉方式(全身麻醉、连续硬膜外麻醉)[18.8%(3/16)、8.0%(14/175)]、是否合并基础疾病[14.7%(10/68)、5.7%(7/123)]、术后低蛋白血症[14.3%(5/35)、8.3%(13/156)]、术后低氧血症[35.7%(15/42)、2.7%(4/149)]、术后电解质紊乱[35.9%(14/39)、3.3%(5/152)]等因素间进行比较,差异均有统计学意义(P<0.05或P<0.01);术后PGS发生率在性别[7.6%(8/105)、10.5%(9/86)]间比较,差异无统计学意义(P>0.05)。③年龄≥70岁(OR=2.218,P<0.05)、手术时间≥90 min(OR=6.326,P<0.05)、全身麻醉(OR=5.575,P<0.05)、合并基础疾病(OR=1.390,P<0.05)、术后低氧血症(OR=1.475,P<0.05)、术后电解质紊乱(OR=6.534,P<0.05)与术后PGS发生相关,且均为危险因素。结论 PGS是由多种因素导致的,上消化道造影及胃镜检查是诊断PGS的可靠方法,保守治疗为其主要治疗手段,应尽量避免再次手术。Objective To analyze the clinical diagnosis, treatment and relevant factor of PGS. Methods 191 patients with abdominal operation from January 1997 to March 2011 in People＇s Hospital of Linqu County were selected. The distributed situation of postoperative PGS in the elements of age, gender, time of operation, way of anesthesia, basic diseases, postoperative hypoproteinemia, postoperative hypoxemia, postoperative electrolyte disturbance were analyzed and compared. Logistic analysis of regression was used to analyze the relative factors of postoperative PGS. Results （~）17 patients with PGS were found and the occurrence rate was 8.9%. （~）The differences of postoperative PGS rate in the elements of age （〈70 years, I〉70 years） [6.1% （7/115）, 13.2% （10/76）], time of operation （〉190 min, 〈90 min） [14.5% （9/62）, 6.2% （8/129）], way of anesthesia （general anesthesia, continual epidural anesthesia） [18.8% （3/16）, 8.0% （14/175）], basic diseases [14.7% （10/68）, 5.7% （7/123）], postoperative hypoalbuminemia [14.3% （5/35）, 8.3% （13/156）], postoperative hypoxemia [35.7% （15/42）, 2.7% （4/149）], postoperative electrolyte disturbance [35.9% （14/ 39）, 3.3% （5/152）] were statistically significant （P 〈 0.05 or P 〈 0.01）. The difference of postoperative psychonosema rate in the elements of gender [7.6% （8/105）, 10.5% （9/86）] was not statistically significant （P 〉 0.05）. （~）Age ~〉70 years （OR = 2.218, P 〈 0.05）, time of operation 〉190 min （OR = 6.326, P 〈 0.05）, general anesthesia （OR = 5.575, P 〈 0.05）, with basic diseases （OR = 1.390, P 〈 0.05）, postoperative hypoxemia （OR = 1.475, P 〈 0.05）, postoperative electrolyte disturbance （OR = 6.534, P 〈 0.05） were found had correlation with postoperative PGS, and all of them were the risk factors, according to the Logistic analysis of regression. Conclusion PGS are caused by many factors, up- per gastrointestinal contrast and gastroscopy a

关 键 词：腹部手术 术后胃瘫综合征 诊断 治疗 

分 类 号：R656.6[医药卫生—外科学]