老年绞窄性小肠梗阻手术相关因素分析  

Analysis of Related Factors in Elderly Patients with Strangulated Small Bowel Obstruction

作　　者：田晶 管文贤[1] 何健[3] 周竹萍[3] 冯敏[1] 汪灏[1] 王军[2] TIANJing;PUAN Wenxian;HEJian;ZHOUZhuping;FENG Min;WANG Hao;WANG Jun(Department of General Surgery,Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University,Nanjing 210008,China;Department of Emergency;Department of Radiology,the Afiliated Drum Tower Hospital of Nanjing University Medical School,Nanjing 210008,China)

机构地区：[1]南京医科大学鼓楼临床医学院医院普外科,南京210008 [2]南京大学医学院附属鼓楼医院急诊中心,南京210008 [3]南京大学医学院附属鼓楼医院放射科,南京210008

出　　处：《中国医学科学院学报》2018年第3期321-327,共7页Acta Academiae Medicinae Sinicae

基　　金：国家重点研发计划(2016YFC0104105)~~

摘　　要：目的分析老年绞窄性小肠梗阻的手术相关因素。方法回顾性分析2010年6月至2016年9月在南京医科大学鼓楼临床医学院医院普外科住院治疗的261例老年急性小肠梗阻患者的临床资料,分为老年绞窄组(ESt组,n=139)和老年单纯组(ESi组,n=122)两组,对两组患者的临床症状、体征、放射学及实验室检测指标进行比较。采用单因素和多因素Logistic回归分析法分析老年绞窄性小肠梗阻的手术相关因素。结果两组患者在肌卫(χ~2=102.331,P=0.000)、美国麻醉师协会(ASA)评分≥3(χ~2=69.748,P=0.000)、白细胞增高(t=7.453,P=0.000)、C反应蛋白(t=2.128,P=0.034)、CT提示肠系膜积液(χ~2=78.655,P=0.000)、肠壁增厚(χ~2=100.806,P=0.000)、肠壁密度增高(χ~2=69.068,P=0.000)、腹水(χ~2=89.299,P=0.000)、肠系膜脂肪密度增高(χ~2=80.255,P=0.000)、鸟嘴征(χ~2=84.451,P=0.000)和缆绳征(χ~2=98.635,P=0.000)方面差异有统计学意义。单因素Logistic回归分析结果显示,上述11个因素均为老年绞窄性小肠梗阻的手术相关因素。进一步多因素Logistic回归结果显示,CT提示肠系膜积液(OR=3.576,95%CI:1.043~12.261,P=0.043)、ASA评分≥3(OR=3.463,95%CI:1.149~10.441,P=0.027)、肌卫(OR=3.288,95%CI:1.010~10.707,P=0.048)、CT提示肠壁增厚(OR=3.046,95%CI:1.074~8.638,P=0.036)和白细胞增高(OR=1.307,95%CI:1.170~1.458,P=0.000)是老年绞窄性小肠梗阻的手术相关因素。结论肌卫、ASA评分≥3、白细胞计数增高、CT提示肠系膜积液和肠壁增厚是老年绞窄性小肠梗阻的手术相关因素。Objective To investigate the surgery-related factors of strangulated small bowel obstruction in the elderly patients. Methods The clinical data of 261 elderly patients with acute small bowel obstruction treated between July 2010 and September 2016 were analyzed retrospectively. Differences of clinical data,labo-ratory results,and CT findings were compared between the elderly strangulation group（ ESt group,n = 139）and the elderly simple group（ ESi group,n = 122）. The surgery-related factors of strangulated small bowel obstruction in the elderly were analyzed by univariate and multivariate Logistic regression analysis. Results The ESt group and the ESi group showed significant differences in factors including muscle guarding（ χ~2= 102. 331,P = 0. 000）,American Society of Anesthesiologists（ ASA） score ≥3（ χ~2= 69. 748,P = 0. 000）,leukocyte count（ t = 7. 453,P = 0. 000）,C-reactive protein（ t = 2. 128,P = 0. 034）,segmental mesenteric fluid（ χ~2=78. 655,P = 0. 000）,thick-walled small bowel（ χ~2= 100. 806,P = 0. 000）,intestinal wall of hyperattenuation（ χ~2= 69. 068,P = 0. 000）,ascites（ χ~2= 89. 299,P = 0. 000）,mesenteric fat stranding（ χ~2= 80. 255,P = 0. 000）,bird＇s beak sign（ χ~2= 84. 451,P = 0. 000）,and stranding sign（ χ~2= 98. 635,P = 0. 000）.Univariate regression analysis indicated the above 11 factors were the surgery-related factors in elderly patients with strangulated small bowel obstruction. Multivariate Logistic regression analysis showed that the surgery-related factors included segmental mesenteric fluid（ OR = 3. 576,95% CI： 1. 043-12. 261,P = 0. 043）,ASA score≥3（ OR = 3. 463,95% CI： 1. 149-10. 441, P = 0. 027）, muscle guarding（ OR = 3. 288,95% CI： 1. 010-10. 707,P = 0. 048）,thick-walled small bowel（ OR = 3. 046,95% CI： 1. 074-8. 638,P = 0. 036）,and increased leukocyte count（ OR = 1. 307,95% CI： 1. 170-1. 458,P = 0. 000）. Conclusion Muscle guarding,ASA score ≥3,segmental mesenteric fluid,thick-walled smal

关 键 词：急性小肠梗阻 绞窄性小肠梗阻 手术相关因素 老年 

分 类 号：R656.1[医药卫生—急诊医学]