绞窄性肠梗阻的危险因素分析及预测模型的建立  

Analysis of the risk factors of strangulated intestinal obstruction and establishment of a prediction model

作　　者：陈宁 赵海剑 张晓雨 CHEN Ning;ZHAO Haijian;ZHANG Xiaoyu(Department of Gastroenterology,Huai′an Hospital Affiliated to Xuzhou Medical University,Huai′an,Jiangsu 223001,China)

机构地区：[1]徐州医科大学附属淮安医院胃肠外科,江苏淮安223001

出　　处：《徐州医科大学学报》2023年第2期79-85,共7页Journal of Xuzhou Medical University

基　　金：江苏省“六大人才高峰”高层次人才科研项目(WSW-220)。

摘　　要：目的研究绞窄性肠梗阻的危险因素并建立预测模型。方法回顾性分析我院2018—2022年收治的200例小肠梗阻患者的临床资料。分析体温、心率、白细胞、中性粒细胞、淋巴细胞、单核细胞、红细胞分布宽度、血小板、C反应蛋白(CRP)、降钙素原等观察指标,采用单因素Logistic回归分析法和多因素Logistic回归分析法分析导致绞窄性肠梗阻的独立危险因素并绘制nomogram图。结果200例小肠梗阻患者中,有83例保守治疗成功,纳入保守治疗组;其余84例患者保守治疗失败行手术治疗,纳入手术治疗组。2组患者是否有腹膜刺激征、是否有腹部手术史、是否合并慢性病、体温、中性粒细胞计数、CRP、降钙素原、白蛋白、前白蛋白、胆碱酯酶、D-二聚体、中性粒细胞与淋巴细胞比值(NLR)、血小板与淋巴细胞比值(PLR)比较,差异有统计学意义(P<0.05);多因素Logistic回归分析显示,白蛋白(OR=0.9,95%CI:0.83~0.98)是导致绞窄性肠梗阻的独立保护因素(P<0.05);是否有腹膜刺激征(OR=18.63,95%CI:2.16~161.06)、是否有腹部手术史(OR=2.88,95%CI:1.25~6.63)、CRP(OR=1.02,95%CI:1.01~1.03)是导致绞窄性肠梗阻的独立危险因素(P<0.05)。结论是否有腹膜刺激征、是否有腹部手术史、CRP、白蛋白与绞窄性肠梗阻密切相关,有一定预测价值。Objective To investigate the risk factors of strangulated intestinal obstruction and construct a prediction model.Methods A total of 200 patients with small bowel obstruction who were admitted to Huai′an Hospital Affiliated to Xuzhou Medical University from 2018 to 2022 were enrolled and their clinical data were retrospectively analyzed.The following observation indexes were analyzed,including body temperature,heart rate,white blood cells,neutrophils,lymphocytes,monocytes,red blood cell distribution width,platelets,CRP,and procalcitonin.The univariate and multivariate Logistic regression analyses were performed to analyze the independent risk factors for strangulating ileus and plot a nomogram.Results Among the 200 patients with small bowel obstruction,83 patients successfully underwent conservative treatment and were included in the conservative treatment group,while the remaining 84 patients who failed in conservative treatment underwent surgical treatment and were included in the surgical treatment group.There were statistical differences between the two groups as to peritoneal irritation,history of abdominal surgery,chronic disease,body temperature,neutrophils,CRP,procalcitonin,albumin,prealbumin,cholinesterase,D-dimer,NLR and PLR(P<0.05).The multivariate logistic regression analysis showed that albumin(OR=0.9,95%CI:0.83-0.98)was an independent protective factor against strangulated intestinal obstruction(P<0.05),while peritoneal irritation(OR=18.63,95%CI:2.16-161.06),history of abdominal surgery(OR=2.88,95%CI:1.25-6.63),and CRP(OR=1.02,95%CI:1.01-1.03)were the independent risk factors for strangulated intestinal obstruction(P<0.05).Conclusions The presence of peritoneal irritationsign,history of abdominal surgery,CRP and albumin are closely related to strangulated intestinal obstruction,with certain predictive value.

关 键 词：绞窄性肠梗阻 危险因素 腹膜刺激征 预后 列线图 

分 类 号：R574.2[医药卫生—消化系统]