本文關(guān)鍵詞： 胃大部切除術(shù) 胃癱綜合征 影響因素 臨床治療　出處：《南華大學(xué)》2015年碩士論文　論文類型：學(xué)位論文

【摘要】：目的探析胃大部切除術(shù)后誘發(fā)胃癱綜合征的影響因素及臨床治療措施,以期為預(yù)防和治療術(shù)后胃癱綜合征提供有利的臨床參考依據(jù)。方法選擇2012年1月~2015年1月在我院胃腸外科進(jìn)行胃大部切除手術(shù)的368例患者為本次研究對象,按照是否發(fā)生術(shù)后胃癱綜合征進(jìn)行分組,胃癱患者為觀察組,無胃癱患者為對照組。對可能誘發(fā)胃癱綜合征的術(shù)前、術(shù)中及術(shù)后因素進(jìn)行比較分析,并選出具有顯著差異的因素進(jìn)行Logistic多元回歸分析。對發(fā)生術(shù)后胃癱綜合征的患者采取綜合治療聯(lián)合個體化治療,評估其治療效果。結(jié)果(1)胃大部切除術(shù)患者總共368例,其中術(shù)后發(fā)生胃癱綜合征28例,其發(fā)病率為7.61%。(2)觀察組患者的年齡、不良心理、術(shù)前幽門梗阻、低蛋白血癥、術(shù)中出血量、胃腸重建方式、手術(shù)時間、手術(shù)方式、手術(shù)時機(jī)、術(shù)后補(bǔ)液量、術(shù)后使用鎮(zhèn)痛泵及術(shù)后不當(dāng)進(jìn)食情況與對照組相比較,差異顯著,具有統(tǒng)計學(xué)意義(P0.05);觀察組患者的性別、高血壓、貧血癥及手術(shù)病因與對照組比較,差異不明顯,無統(tǒng)計學(xué)意義(P0.05)。(3)通過Logistic多元回歸分析結(jié)果顯示,術(shù)前幽門梗阻(OR=7.631)、畢Ⅱ式胃腸重建(OR=13.817)、低蛋白血癥(OR=3.465)、手術(shù)時間≥4h(OR=2.583)屬于胃大部切除術(shù)病人誘發(fā)術(shù)后胃癱綜合征的4個獨立危險因素,且結(jié)果具有統(tǒng)計學(xué)意義(P0.05)。(4)胃癱綜合征患者經(jīng)過治療后,療效達(dá)到一級標(biāo)準(zhǔn)26例(92.86%),二級標(biāo)準(zhǔn)2例(7.14%),三級標(biāo)準(zhǔn)和四級標(biāo)準(zhǔn)均為0例(0%)。結(jié)論誘發(fā)胃癱綜合征的影響因素有很多,年齡、不良心理、術(shù)前幽門梗阻、低蛋白血癥、術(shù)中出血量、胃腸重建方式、手術(shù)時間、手術(shù)方式、手術(shù)時機(jī)、術(shù)后補(bǔ)液量、術(shù)后使用鎮(zhèn)痛泵及術(shù)后不當(dāng)進(jìn)食對其誘發(fā)都具有統(tǒng)計學(xué)意義,而術(shù)前幽門梗阻、胃腸重建方式、低蛋白血癥以及手術(shù)時間是其最重要的4個危險因素,因此胃大部切除術(shù)患者應(yīng)予以積極預(yù)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，

本文編號：1492136