胃大部切除术后胃瘫综合征的影响因素及临床治疗分析

发布时间：2018-02-05 04:35

  本文关键词： 胃大部切除术 胃瘫综合征 影响因素 临床治疗　出处：《南华大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的探析胃大部切除术后诱发胃瘫综合征的影响因素及临床治疗措施,以期为预防和治疗术后胃瘫综合征提供有利的临床参考依据。方法选择2012年1月~2015年1月在我院胃肠外科进行胃大部切除手术的368例患者为本次研究对象,按照是否发生术后胃瘫综合征进行分组,胃瘫患者为观察组,无胃瘫患者为对照组。对可能诱发胃瘫综合征的术前、术中及术后因素进行比较分析,并选出具有显著差异的因素进行Logistic多元回归分析。对发生术后胃瘫综合征的患者采取综合治疗联合个体化治疗,评估其治疗效果。结果(1)胃大部切除术患者总共368例,其中术后发生胃瘫综合征28例,其发病率为7.61%。(2)观察组患者的年龄、不良心理、术前幽门梗阻、低蛋白血症、术中出血量、胃肠重建方式、手术时间、手术方式、手术时机、术后补液量、术后使用镇痛泵及术后不当进食情况与对照组相比较,差异显著,具有统计学意义(P0.05);观察组患者的性别、高血压、贫血症及手术病因与对照组比较,差异不明显,无统计学意义(P0.05)。(3)通过Logistic多元回归分析结果显示,术前幽门梗阻(OR=7.631)、毕Ⅱ式胃肠重建(OR=13.817)、低蛋白血症(OR=3.465)、手术时间≥4h(OR=2.583)属于胃大部切除术病人诱发术后胃瘫综合征的4个独立危险因素,且结果具有统计学意义(P0.05)。(4)胃瘫综合征患者经过治疗后,疗效达到一级标准26例(92.86%),二级标准2例(7.14%),三级标准和四级标准均为0例(0%)。结论诱发胃瘫综合征的影响因素有很多,年龄、不良心理、术前幽门梗阻、低蛋白血症、术中出血量、胃肠重建方式、手术时间、手术方式、手术时机、术后补液量、术后使用镇痛泵及术后不当进食对其诱发都具有统计学意义,而术前幽门梗阻、胃肠重建方式、低蛋白血症以及手术时间是其最重要的4个危险因素,因此胃大部切除术患者应予以积极预防。
[Abstract]:Objective to explore the influencing factors and clinical treatment of post-subtotal gastrectomy induced gastroparesis syndrome. Methods from January 2012 to January 2015, 368 patients undergoing subtotal gastrectomy in our hospital were selected as the subjects. According to whether postoperative gastroparesis syndrome occurred or not, the patients with gastroparesis were divided into observation group and control group. The factors that might induce gastroparesis syndrome before, during and after operation were compared and analyzed. The factors with significant difference were analyzed by Logistic regression analysis. The patients with postoperative gastroparesis syndrome were treated with comprehensive therapy combined with individualized therapy to evaluate the therapeutic effect. Results 1) the total number of patients undergoing subtotal gastrectomy was 368cases. There were 28 cases of postoperative gastroparesis syndrome, the incidence of which was 7.61%.) the age, bad psychology, preoperative pyloric obstruction, hypoproteinemia, intraoperative bleeding volume, gastrointestinal reconstruction mode, operation time, operation mode, operation time, operation time, operation time, operation time, operation time, preoperative pyloric obstruction, hypoproteinemia, operation time, operation mode and operation time were observed. The amount of fluid rehydration, the use of analgesic pump and improper food intake after operation were significantly higher than those in the control group (P 0.05), but there was no significant difference in sex, hypertension, anemia and the etiology of operation between the observation group and the control group. The results of Logistic multiple regression analysis showed that preoperative pyloric obstruction was 7.631, ORII was 13.817, hypoproteinemia was 3.465, operation time 鈮，

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