接受结直肠切除术的炎症性肠病患者加速康复外科方案失败的影响因素分析  

Analysis of factors leading to the failure of enhanced recovery after surgery in inflammatory bowel disease patients with colorectal resection

作　　者：王仲园 李松 谭栋 余泽谦 张腾辉 朱峰 徐艺 李毅 朱维铭 龚剑峰 Wang Zhongyuan;Li Song;Tan Dong;Yu Zeqian;Zhang Tenghui;Zhu Feng;Xu Yi;Li Yi;Zhu Weiming;Gong Jianfeng(Department of General Surgery,Jinling Hospital,Medical School of Nanjing University,Nanjing 210002,China)

机构地区：[1]南京大学医学院附属金陵医院(东部战区总医院)普通外科,南京210002

出　　处：《中华炎性肠病杂志（中英文）》2023年第2期128-134,共7页Chinese Journal of Inflammatory Bowel Diseases

基　　金：国家自然科学基金(81970469)。

摘　　要：目的分析接受结直肠切除术的炎症性肠病(IBD)患者加速康复外科(ERAS)失败的危险因素。方法采用回顾性病例对照研究方法。分析东部战区总医院2019年1月至2021年2月连续收治的在ERAS方案下行结直肠切除术的IBD患者的临床资料。ERAS失败被定义为术后住院时间延长,或术后30 d内再手术、再入院或死亡。根据ERAS失败与否,将患者分为ERAS失败组和ERAS成功组,通过单因素和Logistic多因素分析行结直肠切除术的IBD患者ERAS失败的相关危险因素。结果216例患者被纳入研究,其中ERAS失败组65例,ERAS成功组151例。单因素分析显示,与ERAS成功组相比,ERAS失败组体质量指数(BMI)<18.5 kg/m2的患者比例(61.5%比46.4%,P=0.041),术前营养风险筛查工具2002(NRS-2002)评分≥3分的患者比例(69.2%比48.3%,P=0.005),术前改良格拉斯哥预后评分(mGPS)=2分的患者比例(30.8%比10.6%,P<0.001)、术前4周内使用激素治疗的患者比例(44.6%比23.8%,P<0.001)、实施造口的患者比例(63.1%比46.4%,P=0.024)、术中输液量>3 L的患者比例(44.6%比21.9%,P=0.038)均更高,而术前接受肠内营养治疗的患者比例更低(53.8%比68.2%,P=0.044),差异均具有统计学意义。进一步多因素分析显示,术前NRS-2002评分≥3分(OR=2.212,95%CI:1.133~4.321,P=0.020)、术前mGPS=2分(OR=3.510,95%CI:1.555~7.926,P=0.003)、术前4周使用激素治疗(OR=2.600,95%CI:1.313~5.146,P=0.006)为ERAS失败的独立危险因素。结论术前NRS-2002评分≥3分、术前mGPS=2分和术前4周内使用激素的IBD患者结直肠切除术后更易发生ERAS失败。术前营养预适应、围手术期停用激素以及控制术前炎症反应可能促进IBD手术患者ERAS成功。Objective To analyze the risk factors leading to the failure of enhanced recovery after surgery(ERAS)in inflammatory bowel disease(IBD)patients with colorectal resection.Methods A retrospective case-control study was conducted.Clinical data of consecutive IBD patients who received colorectal resection under ERAS protocol in Jingling Hospital from January 2019 to February 2021 were analyzed.ERAS failure was defined as prolonged postoperative length of hospital stay,or unplanned reoperation,accidental readmission or death within 30 days after operation.The patients were divided into failed ERAS group and successful ERAS group according to whether the ERAS failed.Univariate and Logistic multivariate analyses were performed to identify the risk factors of ERAS failure in IBD patients with colorectal resection.Results A total of 216 patients were enrolled.There were 65 patients in failed ERAS group and 151 in successful ERAS group.Univariate analysis showed that compared with successful ERAS group,the ratio of body mass index(BMI)<18.5 kg/m2(61.5%vs.46.4%,P=0.041),the ratio of preoperative nutritional risk screening tools 2002(NRS-2002)score≥3 points(69.2%vs.48.3%,P=0.005),the ratio of preoperative modified Glasgow prognostic score(mGPS)=2 points(30.8%vs.10.6%,P<0.001),the ratio of preoperative steroids use within 4 weeks before operation(44.6%vs.23.8%,P<0.001),the ratio of neostomy(63.1%vs.46.4%,P=0.024),the ratio of intraoperative infusion volume>3 L(44.6%vs.21.9%,P=0.038)were higher in failed ERAS group,while the the ratio of preoperative enteral nutrition was lower(53.8%vs.68.2%,P=0.044).Multivariate analysis showed that preoperative NRS-2002 score≥3 points(OR=2.212,95%CI:1.133-4.321,P=0.020),mGPS=2 points(OR=3.510,95%CI:1.555-7.926,P=0.003)and preoperative steroids use within 4 weeks before operation(OR=2.600,95%CI:1.313-5.146,P=0.006)were the independent risk factors of ERAS failure in IBD patients with colorectal resection.Conclusions ERAS failure is more likely to occur in IBD patients after colorectal res

关 键 词：炎症性肠病 加速康复外科 营养风险 激素 炎症反应 

分 类 号：R656[医药卫生—外科学]