上消化道溃疡穿孔患者术后24 h乳酸变化趋势对感染并发症的预测价值  

Predictive value of lactic acid change trend for infection complications in patients with perforated upper digestive tract ulcer 24 h after operation

作　　者：王丽杰 周倩云 WANG Lijie;ZHOU Qianyun(Department of Intensive Care,Shougang Hospital,Peking University,Beijing 100041,P.R.China)

机构地区：[1]北京大学首钢医院重症监护科,北京100041

出　　处：《中国普外基础与临床杂志》2024年第9期1112-1118,共7页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的探讨上消化道溃疡穿孔患者术后24 h乳酸水平变化趋势对感染并发症的预测价值。方法选择2021年3月至2023年6月期间于北京大学首钢医院进行手术治疗的167例上消化道溃疡穿孔患者为研究对象,根据病情严重程度分为轻中度组(n=117)和重度组(n=50),比较2组患者的一般资料及术后24 h内乳酸水平。另外,根据患者是否发生并发症分为无并发症组(n=119)和有并发症组(n=48),比较2组患者的一般资料;构建联合模型,采用Cox回归模型分析评估术后24 h乳酸水平的变化与感染并发症的关系;应用logistic回归模型结合限制性立方样条模型分析术后24 h乳酸水平与上消化道溃疡穿孔患者感染并发症的剂量-反应关系;采用log-binomial模型分析并发症种类对上消化道溃疡穿孔患者乳酸水平之间的风险效应。结果轻中度组和重度组患者术后8、16及24 h的乳酸水平均低于术前,且轻中度组患者的乳酸水平均低于重度组(P<0.05);重复测量方差分析显示,轻中度组和重度组患者的乳酸水平在时间效应、组间效应和交互效应方面的差异均具有统计学意义(P<0.05)。有并发症组与无并发症组的上消化道溃疡穿孔患者在术后排气时间、术后住院时间、C-反应蛋白、乳酸水平及红细胞分布宽度方面的差异均具有统计学意义(P<0.05);联合模型显示术后24 h乳酸水平每纵向增加1 mmol/L,感染并发症的风险增加4%;限制性立方样条图显示术后24 h乳酸水平在上消化道溃疡穿孔患者感染并发症中以4.22 mmol/L为剂量-反应关系改变的截点值;log-binomial模型分析结果显示,当乳酸≥4.22 mmol/L时,有并发症组的上消化道溃疡穿孔患者腹腔感染的风险最高,调整因素前后的风险比(95%CI)分别是无并发症组的2.09(1.25,2.64)、2.16(1.28,2.05)和2.20(1.32,2.63)倍,不同乳酸水平的风险比显著性调整前后均具有统计学意义(P<0.05)。结论上消化道溃�Objective To investigate the value of the change trend of lactic acid level 24 h after operation in predicting the complications of upper gastrointestinal ulcer perforation.Methods A total of 167 patients with upper digestive tract ulcer perforation who underwent surgical treatment in Shougang Hospital of Peking University from March 2021 to June 2023 were selected as the study objects,and were divided into mild to moderate group(n=117)and severe group(n=50)according to the severity of the disease.General data and lactic acid levels in 24 h after surgery were compared between the two groups.In addition,according to whether the patients had complications or not,they were divided into a group without complications(n=119)and a group with complications(n=48).The general data of the two groups were compared.A combined model was constructed,and Cox regression model was used to analyze the relationship between the change of lactic acid level at 24 h after operation and the complications of infection.Logistic regression model combined with restricted cubic spline model was used to analyze the dose-response relationship between lactic acid level and infection complications in patients with upper gastrointestinal ulcer perforation 24 h after operation.Log-binomial model was used to analyze the risk effect of complication types on lactic acid levels in patients with upper gastrointestinal ulcer perforation.Results At 8,16 and 24 h after operation,lactic acid levels in both groups(mild to moderate group and severe group)were significantly lower than before operation,and lactic acid level in mild to moderate group was significantly lower than that in severe group(P<0.05).Repeated measurement ANOVA showed that the time effect,intergroup effect and interaction effect of lactic acid levels were significantly different between the two groups(P<0.05).There were significant differences in exhaust time,postoperative hospital stay,C-reactive protein,lactic acid level and red blood cell distribution width between the complicated group

关 键 词：上消化道溃疡穿孔 乳酸 感染并发症 

分 类 号：R656.62[医药卫生—外科学]