食管癌切除术后围术期死亡危险因素的分析及预测模型的建立
发布时间：2019-02-23 22:20
【摘要】：目的:探讨食管癌(Esophageal carcinoma)围术期死亡原因及危险因素,建立logistics回归模型。方法:收集2002年1月至2015年12月于新疆医科大学第一附属医院进行食管癌切除术患者临床资料,食管癌850例,根据围术期及住院期间结局分为死亡和非死亡各一组,将64个可能对食管癌手术死亡有相关影响的常见因素进行回顾性分析,通过计算机用logistics回归模型研究食管癌围术期与死亡原因相关的危险因素,进行单因素、多因素分析,建立回归方程,总结实际意义。结果:850例食管癌中手术死亡39例,手术死亡率4.59%。单因素logistics回归分析,64个因素中,25个因素与食管癌切除术后围术期死亡有关,分别为民族,年龄,术前合并症,术前血红蛋白值,手术切除方式,吻合方式,吻合水平,手术年代,术后白蛋白值,肠内营养时间,ICU治疗时间,心律失常,肺炎、肺部感染,重症肺炎,单侧胸腔积液,双侧胸腔积液,感染性休克,MODS,吻合口瘘,乳糜胸,呼吸衰竭,循环衰竭,呼吸循环衰竭,缺血缺氧综合征等,统计学差异有意义(显著性)(p0.05,具体变量定义详见下文)。多因素logistics回归分析提示手术年代,术后白蛋白值,肠内营养时间,心律失常,MODS,乳糜胸,呼吸衰竭等因素P0.05,有统计学意义,为本研究食管癌围术期死亡原因独立危险因素并进入进入回归方程,获得预测模型为:P=1/1+e^(2.951X25+1.922X27+0.445X30-2.066X32+4.313X50+2.333X55-2.689X58-8.999),(0≤P≤1)。结论食管癌围术期死亡原因分析中,手术年代、术后白蛋白值、心律失常、MODS、乳糜胸、呼吸衰竭等为本研究食管癌围术期死亡原因独立危险因素并进入回归方程,并获得预测模型;欲降低食管癌围术期死亡,需改善医疗环境,提高医疗技术,并在围术期严密观察和评估血清白蛋白值,科学并谨慎开始肠内营养时间,积极预防术后发生心律失常、MODS、乳糜胸、呼吸衰竭等并发症,并尽早处理。
[Abstract]:Objective: to investigate the causes of death and risk factors of esophageal carcinoma during (Esophageal carcinoma) perioperative period and to establish a logistics regression model. Methods: from January 2002 to December 2015, 850 patients with esophageal carcinoma were divided into death group and non-death group according to the outcome of perioperative period and hospital stay, according to the clinical data of the patients undergoing esophageal cancer resection in the first affiliated Hospital of Xinjiang Medical University from January 2002 to December 2015. A retrospective analysis of 64 common factors related to the mortality of esophageal cancer surgery was carried out, and the risk factors related to the causes of death in the perioperative period of esophageal cancer were studied by computer logistics regression model, and the single factor and multivariate analysis were carried out. The regression equation is established and the practical significance is summarized. Results: among 850 cases of esophageal cancer, 39 cases died after operation, and the operative death rate was 4.59%. Univariate logistics regression analysis showed that 25 of 64 factors were related to perioperative death after resection of esophageal carcinoma, including nationality, age, preoperative complications, preoperative hemoglobin value, surgical resection mode and anastomosis level. Year of operation, postoperative albumin value, enteral nutrition time, ICU treatment time, arrhythmia, pneumonia, pulmonary infection, severe pneumonia, unilateral pleural effusion, bilateral pleural effusion, septic shock, MODS, anastomotic fistula, chylothorax, There were significant differences in respiratory failure, circulatory failure, respiratory and circulatory failure, ischemia and hypoxia syndrome, etc. Multivariate logistics regression analysis showed that there were significant differences in serum albumin, postoperative albumin, enteral nutrition time, arrhythmia, MODS, chylothorax, respiratory failure and other factors (P 0.05). In order to study the independent risk factors of perioperative death of esophageal cancer and enter the regression equation, the prediction model was obtained as follows: 1 / 1 e ^ (2.951X25 1.922X27 0.445X30-2.066X32 4.313X50 2.333X55-2.689X58-8.999). (0 鈮，
本文编号：2429268
[Abstract]:Objective: to investigate the causes of death and risk factors of esophageal carcinoma during (Esophageal carcinoma) perioperative period and to establish a logistics regression model. Methods: from January 2002 to December 2015, 850 patients with esophageal carcinoma were divided into death group and non-death group according to the outcome of perioperative period and hospital stay, according to the clinical data of the patients undergoing esophageal cancer resection in the first affiliated Hospital of Xinjiang Medical University from January 2002 to December 2015. A retrospective analysis of 64 common factors related to the mortality of esophageal cancer surgery was carried out, and the risk factors related to the causes of death in the perioperative period of esophageal cancer were studied by computer logistics regression model, and the single factor and multivariate analysis were carried out. The regression equation is established and the practical significance is summarized. Results: among 850 cases of esophageal cancer, 39 cases died after operation, and the operative death rate was 4.59%. Univariate logistics regression analysis showed that 25 of 64 factors were related to perioperative death after resection of esophageal carcinoma, including nationality, age, preoperative complications, preoperative hemoglobin value, surgical resection mode and anastomosis level. Year of operation, postoperative albumin value, enteral nutrition time, ICU treatment time, arrhythmia, pneumonia, pulmonary infection, severe pneumonia, unilateral pleural effusion, bilateral pleural effusion, septic shock, MODS, anastomotic fistula, chylothorax, There were significant differences in respiratory failure, circulatory failure, respiratory and circulatory failure, ischemia and hypoxia syndrome, etc. Multivariate logistics regression analysis showed that there were significant differences in serum albumin, postoperative albumin, enteral nutrition time, arrhythmia, MODS, chylothorax, respiratory failure and other factors (P 0.05). In order to study the independent risk factors of perioperative death of esophageal cancer and enter the regression equation, the prediction model was obtained as follows: 1 / 1 e ^ (2.951X25 1.922X27 0.445X30-2.066X32 4.313X50 2.333X55-2.689X58-8.999). (0 鈮，
本文编号：2429268
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