急性坏疽性胆囊炎危险因素的回顾性分析

发布时间：2018-06-12 12:59

本文选题：急性胆囊炎 + 坏疽　；参考：《山西医科大学》2013年硕士论文

【摘要】：研究目的：急性坏疽性胆囊炎作为临床外科较为棘手的急症，以发病急、病情重、发展快、病死率高而受到全世界各国外科临床医生的广泛关注。该病的治疗需要早期手术干预，才能避免病情进一步恶化。这就需要我们从患者术前的资料（包括基本资料、生命体征、既往史、化验及检查）中，分析得出坏疽性胆囊炎术前、预后危险因素。研究方法： 1. 选取山西医科大学第二医院普外科2008年12月~2012年10月收治的114例胆囊炎患者的病历资料。 2.按照术中探查、术后病理结果分2组，急性坏疽性胆囊炎组和普通胆囊炎对照组，分别为36例和78例患者。 3.通过统计学分析计算比较两组间性别、年龄、入院体温、体重指数、总胆红素、丙氨酸氨基转移酶、天门冬氨酸氨基转移酶、血脂、糖代谢、白细胞计数、胆囊超声影像、心血管疾病病史、是否有结石及既往胆囊炎发作史。 4.最后，利用多变量logistic回归分析多个指标共同对急性坏疽性胆囊炎术前预后的影响。研究结果： 1.在定量资料分析中，入院体温、总胆红素、甘油三酯、白细胞计数因素的两组间差异有统计学意义(P0.05)，这些指标的升高是坏疽性胆囊炎术前、预后的危险因素。 2.在定性资料分析中，性别、入院体温、总胆红素、总胆固醇、白细胞计数、糖代谢、胆囊超声影像因素的两组间差异有统计学意义(P0.05)，这些指标的异常是坏疽性胆囊炎术前、预后的危险因素。 3.在多因素分析中，胆囊超声影像、入院体温、总胆红素与急性坏疽性胆囊炎存在关系密切CP0.05)，且各自的优势比分别为0.141、0.167、0.238。研究结论： 1.通过本实验的临床对照研究，确定坏疽性胆囊炎术前预后危险因素有：男性、入院体温升高、总胆红素升高、白细胞计数升高、糖代谢异常、胆囊超声影像异常。其中胆囊超声影像、入院体温、总胆红素与急性坏疽性胆囊炎存在关系密切； 2.这些术前预后危险因素，，可以指导临床上对急性坏疽性胆囊炎的早期诊断，可作为紧急手术干预的指征。做到对急性坏疽性胆囊炎的“早发现”、“早诊断”、“早治疗”，为广大医务工作者，更是为了百姓的健康服务。
[Abstract]:Objective: acute gangrenous cholecystitis, as a difficult emergency in clinical surgery, has been widely concerned by surgeons all over the world because of its acute onset, severe disease, rapid development and high fatality rate. The treatment of the disease requires early surgical intervention to avoid further deterioration. This requires us to analyze the preoperative prognostic risk factors of gangrenous cholecystitis from the data (including basic data, vital signs, past history, laboratory tests and examinations) of patients with gangrenous cholecystitis. Methods: 1. The medical records of 114 patients with cholecystitis admitted from December 2008 to October 2012 in the General surgery Department of the second Hospital of Shanxi Medical University were selected. 2. According to the intraoperative exploration and pathological results, the patients were divided into two groups: acute gangrenous cholecystitis group and general cholecystitis control group, 36 cases and 78 cases, respectively. Sex, age, body temperature, body mass index, total bilirubin, alanine aminotransferase, aspartate aminotransferase, blood lipid, glucose metabolism, white blood cell count, cholecyst ultrasound imaging were calculated and compared between the two groups. Cardiovascular disease history, whether have stone and previous history of cholecystitis attack. 4. Finally, multivariate logistic regression analysis was used to evaluate the preoperative prognosis of acute gangrenous cholecystitis. Results: 1. In the quantitative data analysis, there were significant differences in the factors of admission temperature, total bilirubin, triglyceride and white blood cell count between the two groups. The increase of these indexes was a risk factor for the prognosis of gangrenous cholecystitis before operation. 2. In qualitative data analysis, there were significant differences in sex, body temperature, total bilirubin, total cholesterol, white blood cell count, glucose metabolism and cholecyst ultrasound between the two groups (P 0.05). The abnormality of these indexes was preoperative gangrenous cholecystitis. Prognostic risk factors. In multivariate analysis, cholecyst ultrasound, body temperature and total bilirubin were closely related to acute gangrenous cholecystitis, and their respective odds ratio was 0.141 ~ 0.167 ~ 0.238. Conclusion: 1. According to the clinical controlled study, the prognostic risk factors of gangrenous cholecystitis before operation were determined as follows: male, admission body temperature, total bilirubin, white blood cell count, abnormal glucose metabolism and abnormal ultrasound image of gallbladder. Among them, ultrasound image of gallbladder, body temperature and total bilirubin were closely related to acute gangrenous cholecystitis. These prognostic risk factors can guide the early diagnosis of acute gangrenous cholecystitis and can be used as an indication of emergency surgical intervention. To achieve "early detection", "early diagnosis" and "early treatment" of acute gangrenous cholecystitis, for the majority of medical workers, but also for the health of the people.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R657.41

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