外伤性单纯结肠损伤急诊手术后并发症发生的危险因素分析  

Analysis of risk factors for complications occurring after emergency surgery for traumatic colon injury

作　　者：张淦 陈志达[2] 刘怡[2] 卢婷婷 董晓宇 郗洪庆[2] Zhang Gan;Chen Zhida;Liu Yi;Lu Tingting;Dong Xiaoyu;Xi Hongqing(Medical School of Chinese PLA,Beijing 100853,China;Division of Abdominal Trauma Surgery,Senior Department of General Surgery,the First Medical Center of Chinese PLA General Hospital,Beijing 100853,China)

机构地区：[1]解放军医学院,北京100853 [2]解放军总医院第一医学中心普通外科医学部腹部创伤外科,北京100853

出　　处：《国际外科学杂志》2023年第12期835-840,共6页International Journal of Surgery

摘　　要：目的探究外伤性结肠损伤行急诊手术后并发症的危险因素。方法采用回顾性队列研究方法,收集解放军总医院2011年3月1日—2023年3月31日确诊为外伤性结肠损伤并行急诊手术的59例患者的病例资料。根据急诊手术后是否发生并发症分为并发症组(n=30)和无并发症组(n=29)。主要观察指标为并发症发生率、并发症Clavien-Dindo分级、并发症发生相关危险因素。正态分布的计量资料以均数±标准差(x^(-)±s)表示,组间比较采用t检验。计数资料组间比较采用χ^(2)检验。使用多因素logistic回归分析,判断具有临床意义的预测术后并发症发生的危险因素。结果30例患者总计出现并发症56次,其中15例患者合并多种并发症。Clavien-Dindo分级为Ⅱ级23例(41.1%),Clavien-Dindo分级为Ⅲa级为1例(1.8%),Clavien-Dindo分级为Ⅲb级为6例(10.7%),Clavien-Dindo分级为Ⅴ级1例(1.8%)。并发症发生率居前三位的分别是肺炎和(或)胸腔积液16例(28.6%),切口感染12例(21.4%),术后出血9例(16.1%)。单因素分析结果显示,体重指数<24 kg/m^(2),手术时长>235 min,术中出血量>100 mL,AAST-OIS分级≥4级,术前血清白蛋白<35 g/L,术前白细胞计数>10×10^(9)/L,术前降钙素原≥2 ng/mL是外伤性结肠损伤术后并发症的危险因素(P<0.05)。多因素logistic回归分析结果显示,体重指数<24 kg/m^(2)(OR=144.047,95%CI:3.695~5614.896,P=0.008)、术前血清白蛋白<35 g/L(OR=116.430,95%CI:3.582~3784.038,P=0.007)、术前降钙素原(PCT)≥2 ng/mL(OR=13.412,95%CI:1.030~174.662,P=0.047)、AAST-OIS分级≥4级(OR=134.509,95%CI:3.934~4599.473,P=0.007)是外伤性结肠损伤术后并发症的危险因素。结论体重指数<24 kg/m^(2)、术前血清白蛋白<35 g/L、术前降钙素原≥2 ng/mL以及AAST-OIS分级≥4级是影响外伤性单纯结肠损伤术后发生并发症的危险因素。对存在危险因素的患者早期给予针对性治疗,有助于改善预后。Objective:To investigate the risk factors for postoperative complications in emergency surgery for traumatic colon injury.Methods:In this study,a retrospective cohort study was used to collect the case data of 59 patients diagnosed with traumatic colon injury and emergency surgery in the PLA General Hospital from March 1,2011 to March 31,2023.According to whether complications occurred after emergency surgery,the patients were divided into the complication group(n=30)and the non-complication group(n=29).The main observation indexes were complication rate,Clavien-Dindo classification of complications,and risk factors related to complications.Normally distributed measurements were expressed as mean±standard deviation(x^(-)±s),and t-test was used for comparison between groups.Count data were compared between groups using the chi-square test.Clinically significant risk factors for predicting the occurrence of postoperative complications were determined by univariate and using multivariate logistic regression analysis.Results:A total of 56 occurrences of complications in 30 cases.15 cases had multiple complications.Clavien-Dindo classification consisted of 23 cases of gradeⅡ(41.1%),1 cases of gradeⅢa(1.8%),6 cases of gradeⅢb(10.7%),and 1 case of grade V(1.8%).The top three complication rates were 16 cases(28.6%)of pneumonia and(or)pleural effusion,12 cases(21.4%)of incision infection,and 9 cases(16.1%)of postoperative bleeding.Univariate analysis showed that body mass index<24 kg/m^(2),operation duration>235 min,intraoperative blood loss>100 mL,AAST-OIS grade≥4,preoperative serum albumin<35 g/L,preoperative white blood cell count>10×10^(9)/L,and preoperative procalcitonin≥2 ng/mL were risk factors for postoperative complications in traumatic colon injury underwent emergency surgery(P<0.05).Multivariate logistic regression analysis showed that body mass index<24 kg/m^(2)(OR=144.047,95%CI:3.695-5614.986,P=0.008),preoperative serum albumin<35 g/L(OR=116.430,95%CI:3.582-3784.038,P=0.007),preoperative procalci

关 键 词：结肠 急诊处理 手术后并发症 危险因素 外伤性结肠损伤 

分 类 号：R656.9[医药卫生—外科学]