重度阻塞性黄疸对手术并发症的影响分析.docVIP

精品论文 参考文献 重度阻塞性黄疸对手术并发症的影响分析 厦门市中医院肝病中心肝外科 361000 摘要：目的：分析大手术后并发症与阻塞性黄疸血清胆红素水平的相关性，探讨加强重度阻塞性黄疸围手术期的处理方法。方法：收集本院2006年9月至2014年4月施行手术治疗的梗阻性黄疸病人病历113例。选取其中施行开腹大手术83例的临床资料进行回顾性分析。分析术后并发症的发生率、再手术率、死亡率与术前血清胆红素水平的关系。结果：术后并发急性肾功能衰竭发生率B组高于A组，差异有显著意义（x2=5.661，Plt;0.05）。术后出血性并发症发生率B组比A组明显增高（x2=4.298，Plt;0.05）。感染性并发症发生率B组显著高于A组（x2=9.711，Plt;0.01）。再手术率B组23.8%比A组7.3%差别显著（x2=4.332，Plt;0.05）。死亡率B组19.05%比A组2.4%差别显著（x2=4.326，Plt;0.05）。结论：血清胆红素水平是预测梗阻性黄疸手术危险性的重要指标之一，术前血清胆红素gt;171mu;mol/ L的病人，特别是血清胆红素gt;342mu;mol/L的病人中术中出血、术后并发症的发生率、再手术率及死亡率明显增高。 关键词：梗阻性黄疽；手术；并发症 Objective To investigate the influence of serious obstructive jaundice on major operation complication.And to explore the method of intensifying the serious obstructive jaundice perioperative management. Methods The clinical data of 113 cases with Obstructive jaundice underwent operation in our department form September 2006 to March2014 were reviewed.Among those 83 cases were underwent the open-abdomen major operation. Result The rate of hemorrhage complication after operation in group B is higher than in groupA（x2=4.298，Plt;0.05）.The rate of infection complication in groupB is higher than in groupA（x2=9.711，Plt;0.01）。The rate of acute renal failure（ARF）after operation in group B is higher than in groupA.The differences are statistically significant（x2=5.661，Plt;0.05）。（x2=4.332、Plt;0.05）；The rate of reoperation in groupB is higher than in groupA.The differences are statistically significant（x2=4.332，Plt;0.05）.And The death rate in groupB is also higher than in groupA.The differences are statistically significant（x2=4.326，Plt;0.05）. Conclusion Obstructive jaundice is one of the major risk factors of operation.Among the preoperative patients with TBIL gt;171mu;mol/L，particularly with TBILgt;342mu;mol/L，the average volume of hemorrhage during operation and The rates of postoperative complications、reoperation and death are all increased obviously.Enforcing the perioperative treat