内镜下结直肠息肉黏膜切除术后迟发出血的高危因素分析  

Risk factors of posstoperative delayed bleeding after endoscopic mucosal resection of colorectal polyps

作　　者：王冬梅[1] 田静静[1] 刘雅莉 贾明贤 石小红 杨磊[1] 赵丽辉[1] WANG Dongmei;TIAN Jingjing;LIU Yali;JIA Mingxian;SHI Xiaohong;YANG Lei;ZHAO Lihui(The First Affi liated Hospital of Zhengzhou University,Zhengzhou,450000,China)

机构地区：[1]郑州大学第一附属医院,河南省郑州市450000

出　　处：《护理实践与研究》2021年第15期2248-2251,共4页Nursing Practice and Research

摘　　要：目的分析内镜下结直肠息肉黏膜切除(EMR)术后迟发出血的高危因素,并讨论防护对策。方法收集2019年1—12月于医院住院并行EMR切除结直肠息肉治疗的2894例患者临床资料,根据是否发生术后迟发性出血分组,其中术后发生迟发出血患者125例作为病例组,未发生迟发出血患者2769例作为对照组。收集两组患者的基本临床资料,采取单因素和多因素Logistic回归模型分析EMR术后迟发出血风险高危因素。结果纳入2894例内镜下结直肠息肉黏膜切除术患者发生术后迟发性出血125例,发生率为4.32%。单因素分析结果显示,两组性别、合并高血压、长期吸烟、息肉直径、息肉数目、术者技术水平、创面处理方式、抗栓药物使用、钛夹使用数量、钛夹倒伏或覆盖不全比较,差异有统计学意义(P<0.05),年龄、息肉山田分型、肠道清洁度分级(Boston分级)3个维度比较,差异无统计学意义(P>0.05)。多因素Logistic回归分析显示,男性、合并高血压,息肉直径≥10 mm、息肉数目≥3枚、抗栓药物使用、钛夹倒伏或覆盖不全是术后迟发出血的独立危险因素(P<0.05)。结论结直肠息肉EMR术后迟发出血的发生与息肉状况、操作者技术、健康宣教相关,医护人员应加强风险意识,提早进行预防性护理干预,减少术后迟发出血风险。Objective To analyze the risk factors of postoperative delayed bleeding after endoscopic colorectal resection(EMR)and discuss the prevention measures.Methods To select 2894 patients'clinic data of whom admitted in the hospital and applied the EMR resection of colorectal polyps from January to December 2019,according to the occurrence of delayed bleeding,125 potients occurred postoperative delayed bleeding were set as case group,2769 patients non-occurred postoperative delayed bleeding were setas control group.To collect the clinic data of two groups,by taking the univariate and multivariate Logistic regression models to analysis the high risk factors of EMR postoperative delayed bleeding.Results There were 125 cases among the 2984 endoscopic colorectal resection patients occurred the postoperative delayed bleeding,the incidence was 4.32%.Univariate analysis results showed that,gender,combined hypertension,long-term smoking,polyp diameter,number of polyps,surgeons'skill level,wound treatment,use of antithrombotic drugs,use of titanium clips,titanium clip collapse or incomplete coverage were compared between the two groups,there were statistically significant difference(P<0.05),while there were no statistically significant difference in the 3 level's comparation which were age,polyp yamada classification and intestinal cleanliness classification(Boston classification)(P>0.05).Multivariate Logistic regression analysis showed that,male,complicated hypertension,polyp diameter≥10 mm,number of polyps≥3,use of antithrombotic drugs,titanium clamping or incomplete coverage were independent risk factors for postoperative delayed bleeding(P<0.05).Conclusion The occurrence of postoperative delayed bleeding after EMR for colorectal polyps was related to the condition of polyps,operator techniques and health education.Medical staff should strengthen risk awareness and carry out preventive nursing intervention in advance to reduce the risk of delayed bleeding after EMR.

关 键 词：直肠息肉 结直肠息肉黏膜切除术 术后迟发出血 高危因素 护理对策 

分 类 号：R473.6[医药卫生—护理学]