医药学论文：非外伤性结直肠穿孔早期死亡率的影响因素分析

【摘要】 目的 探讨非外伤性结直肠穿孔死亡率的影响因素。方法 对从1994～2002年在我院外科治疗的非外伤性结直肠穿孔的62例患者的年龄、性别、穿孔原因、出现症状的时间、术前败血症、伴随疾病（包括心血管疾病、慢性阻塞性肺疾病）、血液透析和降脂治疗、术中发现（穿孔的位置和程度）、术前实验室检查（如白细胞数和血小板数）做回顾性分析，使用单变量和多变量分析研究其和临床转归的关系。结果 术后有12例死亡，通过单变量分析，在死亡病例组内，高龄、败血症、伴随疾病、血液透析、弥漫性腹膜炎、术前血小板减少出现频率较高。Logistic回归分析显示败血症（归因危险度8.513，95％可信区间1.896-41.493），晚期肾衰竭（归因危险度12.567，95％可信区间1.598-109.531）和弥漫性腹膜炎（归因危险度14.367，95％可信区间1.457-118.154）是影响住院期间死亡率的主要因素。结论 在患者全身情况恶化前早期作出诊断是降低死亡率的重要因素，在伴随晚期肾衰竭的患者中尤其重要。

 

【关键词】 预后；结肠；直肠；穿孔；腹膜炎

 

Factors affecting the early mortality of patients with nontraumatic colorectal perforation

 

【Abstract】 Objective We attempted to identify the factors associated with the early mortality of patients with nontraumatic colorectal perforation.Methods 62 patients who underwent surgery for nontraumatic colorectal perforation between May 1994 and December 2002 were retrospectively reviewed.Age, sex, cause of perforation, duration of symptoms, associated preoperative septic shock, concomitant disorders (including cardiac disease, chronic obstructive pulmonary disease, hemodialysis, and steroid treatment), operative findings (such as the site of perforation and the degree of peritonitis), and results of preoperative laboratory blood tests (such as the white blood cell count and platelet count) were analyzed for their association with early outcome using univariate and multivariate analysis.Results 12 of the 62 patients died during hospitalization.According to the univariate analysis,advanced age, preoperative septic shock, concomitant disease, hemodialysis, diffuse peritonitis,and a low preoperative platelet count were more frequent in the patients who died during hospitalization.According to the logistic regression analysis, preoperative septic shock (odds ratio 8.443, 95% confidence interval (CI) 1.896-41.493), concomitant end-stage renal failure (odds ratio 12.567, 95% CI 1.598-109.531), and diffuse peritonitis (odds ratio 14.367, 95% CI 1.457-118.154) were the most significant factors related to in-hospital mortality.Conclusion Early diagnosis before the patient's general condition deteriorates is a key to improving the early mortality associated with nontraumatic colorectal perforation, especially in patients with concomitant end-stage renal failure.

 

【Key words】 prognostic factor;colorectal perforation;peritonitis

 

结直肠穿孔是少见但严重的急腹症。结直肠肿瘤、憩室炎症、肠系膜缺血或者医源性穿孔等许多原因均可引起。虽然外科技术和术后重症监护的不断进步，恶性病变引起的穿孔由于肿瘤病期晚而且合并存在弥漫性腹膜炎，死亡率很高;由良性疾病引起者，除外伤的因素外，预后则取决于原先存在的疾病。由于关于早期预后的研究很少［1～6］，我们回顾性分析我院过去8年收治的62例非外伤结直肠穿孔病例，分析影响早期预后的因素,报告如下。