穿透型克罗恩病病人术后并发症发生的风险和保护性因素

发布时间：2018-04-22 20:33

本文选题：克罗恩病 + 术后并发症　；参考：《肠外与肠内营养》2015年06期

【摘要】：目的:探讨穿透型克罗恩病(CD)术后并发症发生的风险和保护性因素,以期改进术前管理。方法:回顾我科收治的154例接受肠切除吻合手术的穿透型CD病人的临床资料,采用Logistic回归模型分析术后并发症发生的风险和保护性因素。结果:手术后有20例(12.9%)病人出现并发症。多变量分析显示,术前C反应蛋白(CRP,P=0.028,A值:1.687,95%CI:1.059~2.687)是术后并发症发生的风险性因素,且CRP的分界值为26.5 mg/L(P=0.000),敏感性为85.0%,特异性为93.3%。术前营养支持(P=0.021,A值:0.001,95%CI:0.000~0.341)和骨骼肌含量(SMM,P=0.027,A值:0.172,95%CI:0.036~0.815)是术后并发症发生的保护性因素,且SMM的分界值为17.4 kg(P=0.000),敏感性为95.0%,特异性为80.6%。结论:术前应尽可能降低CD的炎性活动,并进行营养支持,以改善病人的营养状况。SMM可作为预测参数,从而改进术前管理、降低术后并发症的发生率。
[Abstract]:Objective: to investigate the risk and protective factors of postoperative complications of penetrating Crohn's disease (CD) in order to improve preoperative management. Methods: the clinical data of 154 patients with penetrating CD undergoing enterectomy and anastomosis were reviewed. The risk and protective factors of postoperative complications were analyzed by Logistic regression model. Results: there were 20 cases with complications after operation. Multivariate analysis showed that preoperative C-reactive protein (CRP) was a risk factor for postoperative complications, with a sensitivity of 85.0 and a specificity of 93.33.The threshold of CRP was 26.5 mg / L, the sensitivity was 85.0 and the specificity was 93.33. Preoperative nutritional support and skeletal muscle content were protective factors for postoperative complications. The threshold value of SMM was 17.4 kgP0.000, sensitivity was 95.00.0.000, specificity was 80.66.The value of nutritional support before operation was 0.021%, the sensitivity was 95.00.34), and the content of skeletal muscle was 0.027 A value: 0.172% 95% CI 0.036 ~ 0.815), and the threshold of SMM was 17.4 kg P0.000, the sensitivity was 95.0, and the specificity was 80.6%. Conclusion: the inflammatory activity of CD should be reduced as much as possible before operation and nutritional support should be carried out in order to improve the nutritional status of patients. SMM can be used as a predictive parameter to improve preoperative management and reduce the incidence of postoperative complications.
【作者单位】：南京大学医学院附属金陵医院(南京军区南京总医院)解放军普通外科研究所;
【基金】：国家自然科学基金资助(81570500,81200263)
【分类号】：R574.62

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