本文關(guān)鍵詞： 靜脈血栓形成 腸系膜 腸壞死 Logistic回歸分析　出處：《青島大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:探討腸系膜上靜脈血栓形成(SMVT)的臨床特點(diǎn)及診治經(jīng)驗(yàn)。方法:回顧性分析我院2006年1月—2016年12月確診的88例SMVT的臨床資料,早期不同治療方式和手術(shù)時(shí)機(jī)的選擇對于患者預(yù)后的影響,根據(jù)是否存在腸梗死將其分成兩組,其中經(jīng)手術(shù)證實(shí)SMVT致腸壞死32例作為研究組,其余56例SMVT作為對照組,對其臨床表現(xiàn)、實(shí)驗(yàn)室檢查、影像學(xué)檢查等綜合指標(biāo)進(jìn)行統(tǒng)計(jì),納入相關(guān)影響因子行多因素Logistic回歸分析,判斷SMVT致腸壞死與臨床危險(xiǎn)因素的關(guān)系,并建立Logistic預(yù)測模型,評價(jià)其預(yù)測SMVT所致腸壞死的準(zhǔn)確度、靈敏度、特異度。結(jié)果:88例SMVT患者中男62例,女26例,年齡53.4±12.4歲,住院期間,生存85例,死亡3例,病死率為3.5%。其中35例患者有腹部手術(shù)史,肝炎、肝硬化患者31例,惡性腫瘤史、心腦血管疾病史患者各4例,糖尿病史3例,系統(tǒng)性紅斑狼瘡1例,另外11例患者未發(fā)現(xiàn)顯高危因素。腹痛為其主要臨床表現(xiàn),占99%,其中持續(xù)性及局限性各占33%、66%。其次分別是腹脹,嘔吐,發(fā)熱及便血等,各占64%、42%、33%、28%,所有患者均經(jīng)過腹部強(qiáng)化CT、DSA、B超或手術(shù)探查,其中腹部強(qiáng)化CT仍為主要確診手段之一,占80%。根據(jù)治療方式不同分為非手術(shù)治療組(n=42),開腹手術(shù)組(n=32)和介入溶栓組(n=14)。與非手術(shù)治療組相比,開腹手術(shù)組住院時(shí)間及術(shù)后肺部感染率偏高(P0.05,差異有統(tǒng)計(jì)學(xué)意義。對于手術(shù)組,早期(T24h接受手術(shù)治療與晚期(T≥24h)接受手術(shù)治療患者相比,晚期患者較早期接受手術(shù)治療腸切除距離偏長,短腸綜合征發(fā)生率偏高(P0.05差異有統(tǒng)計(jì)學(xué)意義。介入治療組與非手術(shù)治療組相比,住院時(shí)間及生存率無明顯統(tǒng)計(jì)學(xué)差異,可作為早期臨床治療方法之一。根據(jù)Logistic回歸模型分析,其中6個(gè)因素進(jìn)入回歸方程,按其作用強(qiáng)弱分為:持續(xù)性腹痛、呼吸頻率、腸壁水腫、術(shù)前白細(xì)胞水平、便血、術(shù)前脈率。Logistic預(yù)測模型對SMVT所致小腸壞死預(yù)測準(zhǔn)確度為85.23%,靈敏度為71.88%,特異度為92.86%,其中kappa值為0.67,證實(shí)該預(yù)測結(jié)果與實(shí)際結(jié)果有較高的一致性。結(jié)論:SMVT發(fā)病情況總體呈現(xiàn)出逐年上升趨勢。腸系膜上靜脈血栓仍主要以腹痛就診。腹部強(qiáng)化CT可作為該病確診首選。血管內(nèi)介入溶栓可作為早期有效治療方法之一。持續(xù)性腹痛、呼吸頻率、腸壁水腫、術(shù)前白細(xì)胞水平、便血、術(shù)前脈率可作為早期臨床判斷腸壞依據(jù),腸壞死征像一但確立,早期剖腹探查可明顯降低腸切除距離。
[Abstract]:Objective: to investigate the clinical features, diagnosis and treatment of superior mesenteric venous thrombosis (SMV). Methods: the clinical data of 88 cases of SMVT diagnosed in our hospital from January 2006 to December 2016 were analyzed retrospectively. According to whether there were intestinal infarction, 32 cases of intestinal necrosis caused by SMVT were selected as the study group, and 56 cases of SMVT were used as control group. The clinical manifestation, laboratory examination, imaging examination and other comprehensive indexes were statistically analyzed, and multivariate Logistic regression analysis was performed to determine the relationship between intestinal necrosis induced by SMVT and clinical risk factors, and to establish a Logistic predictive model. Results the accuracy, sensitivity and specificity of predicting intestinal necrosis caused by SMVT were evaluated in 88 patients with SMVT. Results there were 62 males and 26 females aged 53.4 鹵12.4 years. The mortality rate was 3.5. Among them, 35 patients had abdominal operation history, 31 patients had hepatitis, 31 patients had cirrhosis, 4 patients had history of malignant tumor, 4 patients had history of cardiovascular and cerebrovascular diseases, 3 patients had history of diabetes, and 1 patient had systemic lupus erythematosus. In the other 11 patients, no significant high risk factors were found. Abdominal pain was the main clinical manifestation, accounting for 99%, of which the persistence and limitation accounted for 3366%, followed by abdominal distension, vomiting, fever and bloody stool, etc. Each of them accounted for 64% and 42%, and 28%. All the patients underwent enhanced abdominal CTDSA, B-ultrasound or surgical exploration. Among them, enhanced abdominal CT was still one of the main means of diagnosis. The patients were divided into two groups: the non-operative treatment group (n = 42), the open operation group (n = 32) and the interventional thrombolytic group (n = 14). Compared with the non-operative group, the length of hospitalization and the postoperative lung infection rate in the open operation group were significantly higher than those in the non-operative group (P 0.05). Compared with the patients with advanced stage T 鈮，

本文編號：1524365