腹部手术延迟性术后肠麻痹对术后康复的不良影响  

Negative effect of prolonged postoperative ileus on postoperative recovery in patients underwent open alimentary tract surgery

作　　者：宋建宁[1] 部凡迪 金岚[1] 李俊[1] 杨鋆 吴国聪[1] 姚宏伟[1] 王今[1] 张忠涛[1] 杨盈赤[1] Song Manning;Bu Fandi;Jin Lan;Li Jun;Yang Yun;Wu Guocong;Yao Hongwei;Wang Jin;Zhang Zhongtao;Yang Yingchi(Departmeng of General Surgery,Beijing Firendship Hospital,Capital Medical University,Beijing 100050,China;National Clinical Research Center for Digestive Diseases,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院普外科,国家消化系统疾病中心普外分中心,100050

出　　处：《国际外科学杂志》2021年第8期553-559,共7页International Journal of Surgery

摘　　要：目的:探讨分析开腹消化道手术后发生延迟性肠麻痹(PPOI)对术后住院时间、医疗花费等的不良影响程度。方法:回顾性分析2016年10月—2018年11月首都医科大学北京友谊医院普外科行开腹消化道手术的126例消化道肿瘤患者资料,根据奥克兰大学提出的PPOI诊断标准,将纳入患者分为PPOI组(n=14)和非PPOI组(n=112)。选取术后并发症、术后住院时间以及住院期间医疗花费为研究终点指标。采用t检验或者Fisher精确检验比较两组差异,并通过回归分析探讨PPOI对住院时间、医疗花费的独立影响。结果:本研究队列PPOI发病率为11.1%。PPOI组总并发症发生率升高(64.29%比38.39%,P=0.08)。PPOI组患者术后平均住院时间较非PPOI组较长[(21.21±14.83)d比(13.98±14.21)d,P=0.070]。调整各种可能的混杂因素,影响住院时间的PPOI回归系数beta(95%CI)为[-0.43(-7.16,6.3),P=0.90]。PPOI组患者平均医疗花费较非PPOI组升高[(104389.64±52427.66)元比(79111.41±50832.29)元,P=0.070]。调整各种可能的混杂因素,影响医疗花费的PPOI回归系数beta(95%CI)为[-134.12(-21656.85,21388.62),P=0.99]。结论:延迟性术后肠麻痹导致术后康复的延迟,与术后并发症发生增加相关,增加住院时间和医疗花费。但尚需大样本数据进一步证实。Objective:To analyze the negative effect of prolonged postoperative ileus on postoperative recovery in patients underwent open alimentary tract surgery.Methods:This study was a retrospective cohort study.The subjects of the study were patients who underwent open gastrointestinal surgery at the General Surgery Department of Beijing Friendship Hospital,Capital Medical University from October 2016 to November 2018.According to the PPOI diagnostic criteria proposed by the University of Auckland,the included patients were classified as PPOI Group(n=14)and non-PPOI group(n=112).The postoperative complications,postoperative hospital stay and medical expenses during hospitalization were selected as the study endpoint indicators.T-test or Fisher′s exact test were performed to compare the differences between the two groups,and linear regression analysis was used to explore the independent effects of PPOI on hospital stay and medical expenses.Results:The incidence of PPOI in this study cohort was 11.1%.The total postoperative complications occurred more frequent in PPOI group(64.29%vs 38.39%,P=0.08).The average postoperative hospital stay of patients in the PPOI group was longer than that in non-PPOI group[(21.21±14.83)d vs(13.98±14.21)d,P=0.070].Adjusting for various possible confounding factors,the PPOI regression coefficient beta(95%CI)that affects the length of hospital stay was[-0.43(-7.16,6.3),P=0.90].The average medical cost of patients in the PPOI group was more than that in non-PPOI group[(104389.64±52427.66)元比(79111.41±50832.29)元,P=0.070].Adjusting for various possible confounding factors,the PPOI regression coefficient beta(95%CI)that affects medical expenditure was[-134.12(-21656.85,21388.62),P=0.99].Conclusions:Prolonged postoperative ileus leads to delayed postoperative recovery,which is related to increased postoperative complications,hospital stay duration and medical cost.But it needs further confirmation from large sample data.

关 键 词：腹部 外科手术 住院时间 延迟性术后肠麻痹 医疗花费 

分 类 号：R656[医药卫生—外科学]