内镜黏膜下剥离术后发热相关危险因素分析  

Risk factors for fever after endoscopic submucosal dissection

作　　者：黄蕊[1] 张林慧[1] 张荣春[1] 罗辉[1] 王向平[1] 陶芹[1] 张筱茵[1] 潘阳林[1] 吴开春[1] 刘志国[1] 郭学刚[1] 

机构地区：[1]第四军医大学西京医院消化内科,西安710032

出　　处：《中华消化内镜杂志》2014年第2期72-75,共4页Chinese Journal of Digestive Endoscopy

摘　　要：目的探讨消化道黏膜或黏膜下病变经内镜下黏膜剥离术后发热情况及其相关危险因素。方法回顾分析自2009年11月至2012年4月间270例因消化道黏膜或黏膜下病变行内镜下黏膜剥离术（ESD）患者的相关临床、内镜及病理资料，统计分析以下相关因素：（1）患者相关因素：如性别、年龄、糖尿病史、呼吸系统等其他慢性病史，吸烟史、过敏史、术前预防性使用抗生素情况、白细胞计数。（2）病变相关因素：病变位置、病变大小、浸润深度。（3）操作相关因素：麻醉方式、是否整块切除、术中出血量、操作时间、是否穿孔。结果纳入研究者总共有病例270例，病变275处。56例患者发生ESD术后发热，发生率为20．7％，其中31例（55．4％）在术后24h内发生，发热持续时间为1—8d，平均（1．7±1．4）d，通过单因素及多因素分析，术中穿孔（OR值7．121，95％ CI： 1．740～29．151）及病变位于食管（OR值0．181，95％CI：0．091—0．361）是ESD术后发热的相关危险因素。结论术中穿孔及病变位于食管是ESD术后发热的危险因素，对于食管病变及术中出现穿孔的病例，应警惕术后发热，并予相应处理。Objective To determine the risk factors associated with fever after endoscopic dissection of mucosal/submueosal lesions in gastrointestinal tract. Methods Clinical, endoscopic and pathological data of 275 lesions in 270 ESD patients from November 2009 and April 2012 were collected. The following factors associated with fever were analyzed ： （ 1 ） patient-related factors ： age, sex, concomitant diseases in- eluding diabetes meUitus, chronic disease of respiratory system, history of smoking, history of allergy, white blood cell count before ESD, antibiotic prophylaxis. （2） lesion-related factors ： location, size, infiltration depth. （3） procedure-related factors： anesthesia method, en-bloe resection, operation time, perforation dur- ing ESD. Results A total of 275 lesions in 270 ESD patients,56 patients developed fever after ESD, with the rate of 20. 7%. Among them, 31 eases （55.4%） occurred within 24 hours after ESD. Duration of fever is 1-8 （ 1.7± 1.4） days. Univariate and multivariate analysis revealed that perforation during ESD （ OR： 7. 121,95% CI： 1. 740-29. 151 ） and esophageal lesion （ OR ：0. 181,95% CI：0. 091-0. 361 ） were risk factors for fever after ESD. Conclusion Intraoperative perforation and esophageal lesions were risk factors for fever after ESD. Therefore precautions should be taken for patients with high risk factors during ESD procedure.

关 键 词：发热 危险因素 内镜黏膜下剥离术 

分 类 号：R656[医药卫生—外科学]