胃肠病学
胃腸病學
위장병학
CHINESE JOURNAL OF GASTROENTEROLOGY
2014年
8期
454-457
,共4页
左芦根%朱维铭%李毅%龚剑峰%曹磊%顾立立%李宁%黎介寿
左蘆根%硃維銘%李毅%龔劍峰%曹磊%顧立立%李寧%黎介壽
좌호근%주유명%리의%공검봉%조뢰%고립립%리저%려개수
Crohn病%腹腔感染性并发症%危险因素%Logistic模型
Crohn病%腹腔感染性併髮癥%危險因素%Logistic模型
Crohn병%복강감염성병발증%위험인소%Logistic모형
Crohn Disease%Intra-Abdominal Septic Complications%Risk Factors%Logistic Models
背景：克罗恩病（ CD）术后腹腔感染性并发症（ IASCs）的处理棘手，其预防对于术后CD患者尤为重要。目前国内尚缺乏分析CD术后并发IASCs危险因素的大样本研究。目的：分析CD术后并发IASCs的危险因素，为制订相应预防措施提供参考。方法：回顾性收集1999年-2014年在南京军区南京总医院因CD并发症接受手术治疗者的临床资料。将入选患者分为IASCs组和非IASCs组，选择30个相关影响因素变量，采用单因素和多因素（ Logistic回归）方法分析术后并发IASCs的危险因素。结果：716例次手术纳入分析，IASCs发生率为5.7%（41例）。单因素和多因素分析显示，肠切除一期吻合术（OR=1.656，95% CI：1.261~3.279）、术前白蛋白<30 g/L（OR=1.457，95% CI：1.152~2.368）、术前CRP>10 mg/L（OR=8.641，95% CI：3.376~16.364）、术前激素≥3个月（OR=3.785，95% CI：1.237~4.671）和术中合并腹腔脓肿/感染（OR=1.784，95% CI：1.155~3.826）是CD患者术后并发IASCs的独立危险因素，肠造口术（OR=0.125，95% CI：0.062~0.561）和术前肠内营养≥1个月（OR=0.147，95% CI：0.078~0.781）则为独立保护因素。结论：营养不良、疾病处于活动期和术前使用激素时间过长是CD术后并发IASCs的危险因素，合并上述危险因素者应尽量避免手术；如必须手术，则应选择肠造口术，避免肠切除一期吻合术；术前合理使用肠内营养有望减少术后IASCs的发生。
揹景：剋囉恩病（ CD）術後腹腔感染性併髮癥（ IASCs）的處理棘手，其預防對于術後CD患者尤為重要。目前國內尚缺乏分析CD術後併髮IASCs危險因素的大樣本研究。目的：分析CD術後併髮IASCs的危險因素，為製訂相應預防措施提供參攷。方法：迴顧性收集1999年-2014年在南京軍區南京總醫院因CD併髮癥接受手術治療者的臨床資料。將入選患者分為IASCs組和非IASCs組，選擇30箇相關影響因素變量，採用單因素和多因素（ Logistic迴歸）方法分析術後併髮IASCs的危險因素。結果：716例次手術納入分析，IASCs髮生率為5.7%（41例）。單因素和多因素分析顯示，腸切除一期吻閤術（OR=1.656，95% CI：1.261~3.279）、術前白蛋白<30 g/L（OR=1.457，95% CI：1.152~2.368）、術前CRP>10 mg/L（OR=8.641，95% CI：3.376~16.364）、術前激素≥3箇月（OR=3.785，95% CI：1.237~4.671）和術中閤併腹腔膿腫/感染（OR=1.784，95% CI：1.155~3.826）是CD患者術後併髮IASCs的獨立危險因素，腸造口術（OR=0.125，95% CI：0.062~0.561）和術前腸內營養≥1箇月（OR=0.147，95% CI：0.078~0.781）則為獨立保護因素。結論：營養不良、疾病處于活動期和術前使用激素時間過長是CD術後併髮IASCs的危險因素，閤併上述危險因素者應儘量避免手術；如必鬚手術，則應選擇腸造口術，避免腸切除一期吻閤術；術前閤理使用腸內營養有望減少術後IASCs的髮生。
배경：극라은병（ CD）술후복강감염성병발증（ IASCs）적처리극수，기예방대우술후CD환자우위중요。목전국내상결핍분석CD술후병발IASCs위험인소적대양본연구。목적：분석CD술후병발IASCs적위험인소，위제정상응예방조시제공삼고。방법：회고성수집1999년-2014년재남경군구남경총의원인CD병발증접수수술치료자적림상자료。장입선환자분위IASCs조화비IASCs조，선택30개상관영향인소변량，채용단인소화다인소（ Logistic회귀）방법분석술후병발IASCs적위험인소。결과：716례차수술납입분석，IASCs발생솔위5.7%（41례）。단인소화다인소분석현시，장절제일기문합술（OR=1.656，95% CI：1.261~3.279）、술전백단백<30 g/L（OR=1.457，95% CI：1.152~2.368）、술전CRP>10 mg/L（OR=8.641，95% CI：3.376~16.364）、술전격소≥3개월（OR=3.785，95% CI：1.237~4.671）화술중합병복강농종/감염（OR=1.784，95% CI：1.155~3.826）시CD환자술후병발IASCs적독립위험인소，장조구술（OR=0.125，95% CI：0.062~0.561）화술전장내영양≥1개월（OR=0.147，95% CI：0.078~0.781）칙위독립보호인소。결론：영양불량、질병처우활동기화술전사용격소시간과장시CD술후병발IASCs적위험인소，합병상술위험인소자응진량피면수술；여필수수술，칙응선택장조구술，피면장절제일기문합술；술전합리사용장내영양유망감소술후IASCs적발생。
Background:As postoperative intra-abdominal septic complications( IASCs)in Crohn’s disease( CD)are difficult to manage,it is of great importance to prevent this condition in CD patients after surgery. Till now,there are no large sample studies on risk factors for postoperative IASCs in CD in China. Aims:To determine the risk factors for postoperative IASCs in CD for guiding the formulation of preventive strategies. Methods:This retrospective study was based on a computerized database of CD patients who had undergone surgery for CD complications between 1999 and 2014 at Nanjing General Hospital of Nanjing Military Command,PLA. Patients were divided into IASCs group and non-IASCs group. Thirty potential variables were selected,and both univariate and multivariate( Logistic regression)analyses were performed to identify the risk factors for IASCs after surgery. Results:Seven hundred and sixteen operations were reviewed,and IASCs occurred in 41 cases(5. 7%). By univariate and multivariate analyses,IASCs were significantly associated with one stage anastomosis(OR=1. 656,95% CI:1261-3. 279),preoperative low albumin level( <30 g/L)(OR=1. 457,95% CI:1. 152-2. 368),preoperative high CRP level( >10 mg/L)(OR=8. 641,95% CI:3. 376-16. 364),preoperative steroids use ≥3 months(OR=3. 785,95% CI:1. 237-4. 671)and presence of intra-abdominal abscess or infection at the time of surgery(OR=1. 784,95% CI:1. 155-3. 826). However,enterostomy(OR =0. 125,95% CI:0. 062-0. 561)and preoperative enteral nutrition ≥ 1 month( OR =0. 147,95% CI:0. 078-0. 781 ) were found to be the independent protective factors. Conclusions:Malnutrition,active CD and preoperative long-term steroids use increase the risk of postoperative IASCs in CD. Patients with these risk factors should not receive immediate surgery. If surgery is inevitable, enterostomy instead of resection and anastomosis should be the first choice. Preoperative enteral nutrition is helpful for reducing the occurrence of IASCs after surgery.
