影响小儿腹腔镜下腹股沟疝修补术后效果的危险因素及护理对策  

Risk Factors Affecting Outcomes After Laparoscopic Inguinal Hernia Repair in Children and Nursing Interventions

作　　者：王玲玲[1] 张之臣 韩玲[1] WANG Lingling;ZHANG ZhiChen;HAN Ling(Department of General Surgery,Xinxiang Central Hospital,Xinxiang Henan 453000,China;Department of Urology,Xinxiang Fourth People's Hospital,Xinxiang Henan 453000,China)

机构地区：[1]河南省新乡市中心医院普通外科,河南新乡453000 [2]新乡市第四人民医院泌尿外科,河南新乡453000

出　　处：《临床研究》2025年第1期143-147,共5页Clinical Research

摘　　要：目的探究小儿腹腔镜下腹股沟疝修补术(LIHR)后效果的危险因素及护理对策。方法回顾性分析河南省新乡市中心医院2021年5月至2022年5月收治的87例腹股沟疝患儿的临床资料,根据术后恢复情况将患儿分为恢复良好组及恢复不良组,收集两组患者的一般社会学特征和疾病相关特征,选择Logistic回归分析有差异项目,分析腹股沟疝患儿接受LIHR术后恢复不良的主要影响因素,并构建受试者工作特征(ROC)曲线对危险因素的预测效能进行验证。结果本研究共纳入87例行LIHR术患儿,23例患儿恢复较差,占26.44%,纳入恢复不良组,64例患儿恢复良好,占73.56%,纳入恢复良好组;两组患儿在哭闹情况、术前年龄别体重Z值(WAZ)、疝嵌顿、改良的耶鲁术前焦虑状态量表(m-YPAS)评分及TIMP-2比较,差异有统计学意义(P<0.05)。经Logistic回归方程分析,患儿哭闹多、术前WAZ值≤-2、发生疝嵌顿、m-YPAS评分>40分及TIMP-2水平偏低均是患儿术后恢复不良的危险因素。基于多因素分析的危险因素构建ROC曲线,结果显示哭闹情况的曲线下面积(AUC)值为0.712,敏感度为0.783,特异度为0.641;术前WAZ值≤-2的AUC值为0.698,敏感度为0.739,特异度为0.656;疝嵌顿的AUC值为0.678,敏感度为0.652,特异度为0.703;m-YPAS评分>40的AUC值为0.692,敏感度为0.696,特异度为0.688;TIMP-2水平偏低的AUC值为0.694,敏感度为0.531,特异度为0.870,均能预测术后恢复不良的发生。结论哭闹多、术前WAZ值≤-2、嵌顿疝、m-YPAS评分>40分及术前TIMP-2水平较低均是影响腹股沟疝患儿LIHR术后恢复不良的危险因素,护理人员应予以重视,采取有效措施,提高患儿预后。Objective To explore the risk factors affecting outcomes after laparoscopic inguinal hernia repair(LIHR)and to propose nursing interventions.Methods A retrospective analysis was performed on the clinical data of 87 children with inguinal hernia admitted to Xinxiang Central Hospital from May 2021 to May 2022.Based on postoperative recovery status,the children were divided into a good recovery group and a poor recovery group.General sociological characteristics and disease-related features of both groups were collected.Logistic regression analysis was conducted on the items with differences to identify the main influencing factors of poor recovery in children undergoing LIHR,and receiver operating characteristic(ROC)curves were constructed to verify the predictive efficacy of these risk factors.Results Among the 87 children undergoing LIHR,23 had poor recovery,accounting for 26.44%,while 64 had good recovery,accounting for 73.56%.There were statistically significant differences between the two groups in terms of crying behavior,preoperative weight-for-age Z-score(WAZ),incidence of hernia incarceration,scores on the modified Yale Preoperative Anxiety Scale(m-YPAS),and TIMP-2 levels(P<0.05).Logistic regression analysis revealed that excessive crying,WAZ≤-2,hernia incarceration,m-YPAS score>40,and low TIMP-2 levels were all risk factors for poor postoperative recovery.ROC curve analysis based on these multivariate risk factors showed an area under the curve(AUC)of 0.712 for crying behavior(sensitivity:0.783,specificity:0.641);for WAZ≤-2,the AUC was 0.698(sensitivity:0.739,specificity:0.656);for hernia incarceration,the AUC was 0.678(sensitivity:0.652,specificity:0.703);for m-YPAS score>40,the AUC was 0.692(sensitivity:0.696,specificity:0.688);and for low TIMP-2 levels,the AUC was 0.694(sensitivity:0.531,specificity:0.870),all of which can predict poor postoperative recovery.Conclusion Factors such as excessive crying,preoperative WAZ≤-2,hernia incarceration,m-YPAS score>40,and low preoperative TIMP-2 levels are

关 键 词：腹股沟疝 腹腔镜腹股沟疝修补术 疝嵌顿 营养不良 

分 类 号：R473.72[医药卫生—护理学]