胃大部切除术后胃瘫综合征的危险因素分析.docVIP

精品论文 参考文献 胃大部切除术后胃瘫综合征的危险因素分析 邓瑞华 （湖南省临湘市中医院普外科 414308） 　　【摘要】目的 探讨胃大部切除术后发生胃瘫综合征(PGS)的危险因素。方法回顾性分析在我院行胃大部切除术310例患者的临床资料，以发生PGS作为观察组，未发生PGS作为对照组，对两组患者的自身因素、手术因素、术后因素进行单因素分析及Logistic回归分析。结果 310例患者共发生PGS15例(4.84％)。单因素分析与PGS有关因素分别为年龄大、术前幽门梗阻、术后高血糖、围手术期低蛋白血症、恶性疾病、毕Ⅱ式、手术时间长、术中出血量多、不良心理、应用镇痛泵、腹腔感染、术后肠内营养时间晚(Plt;0．05)。对独立危险因素进行Loigstic回归分析，按OR值的大小前四位依次为：术前幽门梗阻、围手术期低蛋白血症、毕Ⅱ式、不良心理。结论PGS发生是多种因素作用的。结果 临床上应妥善处理幽门梗阻，尽量采取毕I式胃肠吻合，缩短手术时间，控制血糖，提高血清白蛋白，加强心理支持来预防和减少PGS发生。 　　【关键词】胃瘫综合征 胃大部切除 危险因素 　　【中图分类号】R656.6+1 【文献标识码】A 【文章编号】1672-5085（2014）14-0066-03 　　【Abstract】Objective:To explore the risk factors of postsurgical gastroparalysis syndrome(PGS) after subtotal gastrectomy.Methods:310 cases of subtotal gastrectomy were retrospectively analyzed,the cases of PGS were observational group,and the non-PGS were control group,mono-factor analysis and Logistic regression analysis were performed toward the personal factors,surgical factors and postsurgical factors.Results:15 out of 310 cases were PGS(4.84%),the age, preoperative pyloric obstruction,postoperative hyperglycemia,perioperative hypoproteinemia,Billroth II gastrectomy,long operation time,the amount of intraoperative bleeding,unhealthy psychology,using patient control analgesia,abdominal infection,postoperatively intestinal nutrition late were associated with the PGS by the mono-factor analysis(plt;0.05).the results derived from the logistic regression analysis toward the independent risk factor pointed that the top four factors were arranged in according to the value of OR,preoperative pyloric obstruction,perioperative hypoproteinemia,Billroth II gastrectomy,unhealthy psychology.Conclusions:the incidence of PGS were derived from many factors,treat pyloric obstruction properly,Billroth I gastrectomy,shorten the operation time,control glycemia,improve the serum albumin,and strong the psychological support can prevent and reduce PGS. 　　【Key words】gastroparesis synodrom