本文選題：賁門癌 + 危險(xiǎn)因素�。� 參考：《廣東醫(yī)學(xué)》2017年15期

【摘要】：目的探討并分析賁門癌圍術(shù)期死亡原因及術(shù)后并發(fā)癥危險(xiǎn)因素,建立logistics回歸模型。方法收集305例賁門癌切除術(shù)患者的臨床資料,根據(jù)圍術(shù)期及住院期間術(shù)后有無發(fā)生并發(fā)癥分為兩組,將33個(gè)可能對賁門癌術(shù)后發(fā)生并發(fā)癥有相關(guān)影響的有代表性的因素進(jìn)行回顧性分析,通過計(jì)算機(jī)用logistic回歸模型分析術(shù)后并發(fā)癥相關(guān)危險(xiǎn)因素,進(jìn)行單因素、多因素、相關(guān)性及共線性檢驗(yàn)分析,并建立風(fēng)險(xiǎn)預(yù)測模型,總結(jié)實(shí)際意義。結(jié)果305例賁門癌中手術(shù)死亡7例,手術(shù)死亡率2.3%。死亡原因:循環(huán)系統(tǒng)并發(fā)癥2例(包括心源性休克并急性冠脈綜合征1例,心源性猝死1例,占死亡組的28.60%),呼吸系統(tǒng)并發(fā)癥2例(包括肺部感染、重癥肺炎、肺不張等引起的呼吸衰竭2例,占死亡組的28.60%),呼吸系統(tǒng)與循環(huán)系統(tǒng)并發(fā)癥并存3例(包括呼吸循環(huán)衰竭2例,呼吸衰竭并心肌梗死1例,占死亡組的42.80%),吻合口瘺1例(14.30%),乳糜胸1例(14.30%)。單因素logistic回歸分析顯示,在所分析的33個(gè)因素中,有9個(gè)因素與賁門癌切除術(shù)后發(fā)生并發(fā)癥有關(guān),分別為術(shù)前合并心臟病、病變部位、手術(shù)時(shí)長、手術(shù)切除范圍、手術(shù)年代、術(shù)中輸血、術(shù)中出血量、腸內(nèi)營養(yǎng)時(shí)間、重癥監(jiān)護(hù)室(ICU)治療時(shí)間,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。多因素logistic回歸分析提示:術(shù)前合并心臟病、手術(shù)切除范圍、術(shù)中輸血、腸內(nèi)營養(yǎng)時(shí)間等指標(biāo)有統(tǒng)計(jì)學(xué)意義(P0.05),術(shù)前合并心臟病為獨(dú)立危險(xiǎn)因素,術(shù)中輸血為保護(hù)因素,并進(jìn)入logistic回歸方程,獲得預(yù)測模型P=1/(1+e~((18.256-1.079X33+0.963X19-0.788X26+0.725X30)))。結(jié)論合并心臟病的賁門癌患者手術(shù)評估需嚴(yán)格掌握,欲防止并發(fā)癥發(fā)生,圍術(shù)期需注意心功能的動(dòng)態(tài)變化,保證心功能能夠維持機(jī)體正常生理功能;手術(shù)切除范圍愈大,術(shù)后并發(fā)癥發(fā)生風(fēng)險(xiǎn)愈高,故術(shù)中應(yīng)根據(jù)病變部位和范圍在切除病變的前提下盡可能減少創(chuàng)傷,有助于減少術(shù)后并發(fā)癥的發(fā)生;賁門癌手術(shù)創(chuàng)傷較大,術(shù)中予輸血有助于術(shù)后減少術(shù)后并發(fā)癥發(fā)生;腸內(nèi)營養(yǎng)時(shí)間的合理性與科學(xué)性能影響圍術(shù)期并發(fā)癥發(fā)生率,故需結(jié)合具體病情開始腸內(nèi)營養(yǎng)時(shí)間并需動(dòng)態(tài)觀察營養(yǎng)前后機(jī)體的變化。
[Abstract]:Objective to investigate the causes of perioperative death and risk factors of postoperative complications of cardiac carcinoma and to establish a logistics regression model. Methods the clinical data of 305 patients with cardiac cancer resection were collected and divided into two groups according to the complications during perioperative period and hospitalization. A retrospective analysis of 33 representative factors related to postoperative complications of cardiac cancer was carried out. The related risk factors of postoperative complications were analyzed by logistic regression model. Correlation and collinearity analysis and risk prediction model are established to summarize the practical significance. Results among 305 cases of cardiac carcinoma, 7 cases died, and the operative death rate was 2.3%. The causes of death included 2 cases of circulatory complications (including 1 case of cardiogenic shock and acute coronary syndrome, 1 case of sudden cardiac death, 28.60% of death group), 2 cases of respiratory complications (including pulmonary infection, severe pneumonia). There were 2 cases of respiratory failure caused by atelectasis, 28.60% of death group, 3 cases of respiratory and circulatory complications (including 2 cases of respiratory and circulatory failure, 1 case of respiratory failure and myocardial infarction). In the death group, 42.80 cases had anastomotic fistula, 1 case had anastomotic fistula and 1 case had chylothorax. Univariate logistic regression analysis showed that 9 of the 33 factors were associated with postoperative complications of cardiac cancer, including preoperative heart disease, location of lesion, length of operation, resection range, and age of operation. There were significant differences in blood transfusion, intraoperative blood loss, enteral nutrition time and ICU treatment time in intensive care unit (ICU). Multivariate logistic regression analysis showed that preoperative heart disease, surgical resection range, intraoperative blood transfusion, time of enteral nutrition were statistically significant (P 0.05), preoperative heart disease was an independent risk factor, and intraoperative blood transfusion was a protective factor. After entering the logistic regression equation, the prediction model P ~ (1 / 1) e~((18.256-1.079X33 0.963X19-0.788X26 0.725 X _ (30) was obtained. Conclusion the surgical evaluation of cardiac cancer patients with heart disease should be strictly grasped. In order to prevent complications, attention should be paid to the dynamic changes of cardiac function in perioperative period to ensure that cardiac function can maintain normal physiological function. The higher the risk of postoperative complications is, the more trauma should be minimized under the premise of resection according to the location and scope of the lesion, which is helpful to reduce the incidence of postoperative complications. Intraoperative transfusion was helpful to reduce postoperative complications, and the rationality of enteral nutrition time and scientific performance affected the incidence of perioperative complications. Therefore, it is necessary to start enteral nutrition time combined with specific condition and observe the changes of body before and after nutrition.
【作者單位】： 新疆醫(yī)科大學(xué)第一附屬醫(yī)院胸外科;
【分類號】：R735

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