肥胖型急性阑尾炎病人临床特征分析  

Clinical Characteristics of Obese Patients with Acute Appendicitis

作　　者：欧阳军[1] 沈长兵[1] 秦菊芳[1] 谢伟[2] 范崇晔 李玺[4] 

机构地区：[1]泰州市第二人民医院普外科,江苏泰州225500 [2]徐州医学院研究生院,江苏徐州221000 [3]湖南长沙医学院,湖南长沙410219 [4]中国人民解放军第97医院普外科,江苏徐州221004

出　　处：《医学临床研究》2015年第12期2353-2355,2358,共4页Journal of Clinical Research

摘　　要：【目的】探讨肥胖型患者急性阑尾炎的临床特点，提高临床诊断效率。【方法】回顾性分析2013年1月至2014年3月收入本院并行手术治疗的176例急性阑尾炎患者临床资料。用体质量指数（Body Mass Index，BMI）定义肥胖，标准为BMI≥28。纳入比较肥胖型患者急性阑尾炎与非肥胖患者急性阑尾炎的发病特征，并对肥胖型急性阑尾炎病人预后行多因素logistic回归分析。[结果]176例急性阑尾炎患者中，肥胖型患者41例，非肥胖型患者135例；肥胖型患者体温、白细胞计数高于非肥胖型患者（P〈0．05）；淋巴细胞百分率小于非肥胖型患者（P〈0．05）；中性粒细胞百分率、总胆红素（TB）、直接胆红素（DB）、间接胆红素（IB）、住院时间及住院费用、术后并发症均显著高于非肥胖型患者（P〈0．01）；肥胖患者重型阑尾炎（坏疽性、穿孔性、坏疽合并穿孔性）比例高于非肥胖组（P〈0．05）。多因素10gistic回归分析示：中性粒细胞百分率、总胆红素、病理类型及术后并发症是肥胖型阑尾炎病人预后的独立危险因素（P〈0．05）。【结论】肥胖型患者急性阑尾炎临床特征不典型，预后较非肥胖患者差，临床积极的早期诊断、合理控制危险因素尤为重要。[Objective]To study the clinical characteristics of obese patients with acute appendicitis to improve the efficiency of its clinical diagnosis. [Methods]A retrospective analysis made up of clinical data from 176 cases of acute appendicitis patients receiving parallel surgical treatment in our hospital from January of 2013 to March of 2014. Obesity was defined as body mass index （BMI） greater than or equal to 28. Clinical characteristics were compared between non-obese and obese patients. The prognosis of obese patients was analyzed by multivariate logistic regression. [Results]There were 176 patients, of which 41 patients were obese and 135 patients were non-obese. Higher body temperature and WBC count were detected in obese patients than those in non-obese patients （ P 〈0.05）; the lymphocyte percentage in obese patients, however, was lower than that in non-obese patients （ P 〈0.05）. Neutrophil percentage, total bilirubin （TB）, direct bilirubin （DB）, indirect bilirubin （IB）, length of hospital stay, hospital costs, and postoperative complications in obese patients were significantly higher than those in non-obese patients （P 〈0.01）. The ratio of severe appendicitis （gangrenous, perforated, gangrenous perforated consolidation） in obese patients was higher than that in the non-obese group （P 〈0.05）. Multivariate logistic regression analysis revealed that the lymphocyte percentage, TB, pathologic types, and postoperative complications were independent risk factors for obese patients with acute appendicitis （ P 〈0.05）. [Conclusion]The clinical characteristic analysis of actual appendicitis in obese patients is atypical and inconclusive. The prognosis of obese patients is worse compared with non-obese patients, indicating that the early clinical diagnosis and reasonable control of risk factors are particularly important.

关 键 词：阑尾炎 急性病 肥胖症 早期诊断 危险因素 

分 类 号：R574.61[医药卫生—消化系统]