【摘要】：目的探討腹膜透析管安置術(shù)后患者發(fā)生腹膜透析管大網(wǎng)膜包裹的危險因素。方法選取2007年1月—2015年12月間在上海長海醫(yī)院腎內(nèi)科行常規(guī)腹膜透析管安置術(shù)的患者626例,其中術(shù)后發(fā)生大網(wǎng)膜包裹導致引流不暢29例(包裹組),未發(fā)生大網(wǎng)膜包裹597例(對照組)。對兩組患者的臨床資料進行比較,采用Logistic多元回歸分析腹膜透析管安置術(shù)后大網(wǎng)膜包裹發(fā)生的危險因素。結(jié)果包裹組中,術(shù)后當天發(fā)生大網(wǎng)膜包裹2例,術(shù)后1~5d發(fā)生大網(wǎng)膜包裹4例,術(shù)后6~10d發(fā)生大網(wǎng)膜包裹10例,術(shù)后11~15d發(fā)生大網(wǎng)膜包裹10例,術(shù)后15d發(fā)生大網(wǎng)膜包裹3例。包裹組的BMI、身高和甲狀旁腺激素水平均顯著低于對照組(P值均0.05),便秘患者構(gòu)成比、術(shù)后疼痛視覺模擬評分均顯著高于對照組(P值均0.05),術(shù)后下床活動時間(手術(shù)結(jié)束至患者首次下床活動的時間)顯著晚于對照組(P0.05),血鉀、三酰甘油和膽固醇水平均顯著高于對照組(P值均0.05);兩組間切口至恥骨聯(lián)合距離和血紅蛋白、血鈣、血清鐵、血磷、血清肌酐、白蛋白水平的差異均無統(tǒng)計學意義(P值均0.05)。多因素Logistic回歸分析顯示,術(shù)后疼痛視覺模擬評分(OR=2.311,95%CI為0.975~5.479)、術(shù)后下床活動時間(OR=2.192,95%CI為1.337~3.595)和三酰甘油水平(OR=2.160,95%CI為1.427~5.319)是腹膜透析管術(shù)后大網(wǎng)膜包裹發(fā)生的獨立危險因素(P值均0.05)。結(jié)論腹膜透析管安置術(shù)后大網(wǎng)膜包裹多發(fā)生于術(shù)后2周以內(nèi),術(shù)后疼痛視覺模擬評分、下床活動時間和三酰甘油水平是發(fā)生腹膜透析管大網(wǎng)膜包裹的獨立危險因素。
[Abstract]:Objective to investigate the risk factors of greater omentum encapsulation of peritoneal dialysis tube after peritoneal dialysis tube placement. Methods from January 2007 to December 2015, 626 patients underwent routine peritoneal dialysis tube placement in the Department of Nephrology, Changhai Hospital in Shanghai. There were 29 cases (package group) and 597 cases (control group) with unobstructed drainage caused by greater omentum wrapping after operation. The clinical data of the two groups were compared and the risk factors of omentum encapsulation after peritoneal dialysis tube placement were analyzed by Logistic regression analysis. Results in the package group, there were 2 cases of greater omentum wrapping on the day of operation, 4 cases of greater omentum wrapping on the 5th day after operation, 10 cases of greater omentum wrapping on 610 days after operation, 10 cases of greater omentum wrapping on 1115 days after operation, and 3 cases of greater omentum wrapping on 15 days after operation. The BMI, height and parathyroid hormone level in the package group were significantly lower than those in the control group (P < 0. 05). The visual analogue score of postoperative pain was significantly higher than that of the control group (P < 0.05), and the time of getting out of bed after operation (the time from the end of operation to the first time of the patient getting out of bed) was significantly later than that of the control group (P0.05). The levels of triacylglycerol and cholesterol were significantly higher than those in the control group (P < 0.05), but there was no significant difference in the distance between incision and pubic association and the levels of hemoglobin, serum calcium, serum iron, serum phosphorus, serum creatinine and albumin between the two groups (P < 0.05). Multivariate Logistic regression analysis showed that postoperative pain visual analogue score (OR=2.311,95%CI = 0.975 鹵5.479), postoperative time of getting out of bed (OR=2.192,95%CI = 1.337 鹵3.595) and triacylglycerol level (OR=2.160,95%CI = 1.427 鹵5.319) were independent risk factors of omentum encapsulation after peritoneal dialysis tube operation (P < 0. 05). Conclusion after peritoneal dialysis tube placement, omentum encapsulation mostly occurs within 2 weeks after operation. Visual analogue score of postoperative pain, time of getting out of bed and level of triglyceride are independent risk factors for the occurrence of greater omentum encapsulation of peritoneal dialysis tube.
【作者單位】： 上海長海醫(yī)院腎內(nèi)科;
【基金】：國家自然科學基金資助項目(81500583)
【分類號】：R692

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