中国实用外科杂志

中国实用外科杂志

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肠瘘合并腹腔出血危险因素及其预后分析

吴    磊，任建安，王革非，洪之武，任华建，吴秀文，刘秦杰，黎介寿   

  1. 南京大学医学院附属金陵医院 普通外科研究所，江苏南京210002
  • 出版日期:2016-10-01 发布日期:2016-09-28

  • Online:2016-10-01 Published:2016-09-28

摘要：

目的    探讨肠瘘病人并发腹腔出血的危险因素，评价腹腔出血对肠瘘病人预后的影响。方法    回顾性分析南京大学医学院附属金陵医院普通外科2013年10月至2015年10月201例肠瘘病人的临床资料,其中67例病人住院期间出现腹腔出血（并发出血组），134例病人住院期间未出现腹腔出血（未并发出血组），分析腹腔出血的风险因素及预后情况。结果    logistic回归提示十二指肠瘘（OR 3.348，95%CI 1.215～9.231，P=0.019）、入院前腹腔出血史（OR 10.698，95%CI 4.447～25.737，P<0.001）及急性肾损伤（OR 6.090，95%CI 2.408～15.405，P＜0.001）是肠瘘病人并发腹腔出血的独立危险因素。与未合并出血组相比，合并出血组病死率明显较高，肠外营养时间，重症监护室住院天数明显延长，相关并发症的发生率及住院费用明显较高（P<0.05）。结论    十二指肠瘘、人院前腹腔出血病史及合并急性肾功能损伤是肠瘘并发腹腔出血的独立危险因素。肠瘘合并腹腔出血病情凶险，病死率高，病人预后较差。

关键词: 肠瘘, 腹腔出血, 风险因素

Abstract:

Risk factors and prognosis for intra-abdominal bleeding in patients with enterocutaneous fistula        WU Lei，REN Jian-an，WANG Ge-fei，et al. Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, China
Corresponding author:REN Jian-an, E-mail：jiananr@gmail.com
Abstract    Objective    To investigate the risk factors for intra-abdominal bleeding in patients with enterocutaneous fistula and assessed the prognosis of these patients. Methods    The clinical data of 201 cases of enterocutaneous fistula patients admitted from October 2013 to October 2015 in Jinling Hospital, Medical School of Nanjing University, were analyzed retrospectively. The patients were classified as bleeding group(67 cases) and non-bleeding group(134 group)，risk factors for intra-abdominal bleeding and prognosis of patients were analyzed. Results    In the multivariate logistic regression analysis, duodenum fistula (OR 3.348, 95%CI 1.215～9.231, P=0.019), hemorrhage history (OR 10.698,95%CI 4.447～25.737, P<0.001) and acute kidney injury (OR 6.090  95%CI 2.408～15.404, P＜0.001) were independent risk factors for intra-abdominal bleeding. In addition, compared with the non-bleeding group, bleeding group showed a significantly higher mortality rate, more prolonged total parenteral nutrition days, hospital and intensive care unit durations and cost, even more complications. Conclusion    In duodenum fistula, hemorrhage history and acute kidney injury were independent risk factors for intra-abdominal bleeding. Intra-abdominal bleeding in patients with enterocutaneous fistul is under dangerous condition, the death rate is high, and associated with a poor prognosis.

Key words: enterocutaneous fistula, intra-abdominal bleeding, risk factor