摘要
目的 探讨引起术后胃瘫综合征（PGS）相关因素,为制定针对性预防措施提供客观依据.方法 2002年1月至2009年6月对我院所有胃大部切除术患者280例,以PGS者作为观察组,非PGS者作为对照组,对可能影响PGS因素进行单因素分析与Logistic回归分析.结果 280例患者共发生PGS20例（7.14%）.单因素分析与PGS有关因素分别为年龄大、围手术期高血糖、贫血、低蛋白血症、术前有消化道梗阻、术前非肠内营养、毕Ⅱ式、手术时间长、广泛淋巴结清扫、术中出血量多、应用自控镇痛泵、腹腔感染、术后肠内营养时间晚（P〈0.05）,而PGS的发生与性别无关（P〉0.05）.非条件多因素分析,选出4个主要的危险因素：围手术期高血糖（OR=3.123）.低总蛋白血症（OR=3.098）,毕Ⅱ式（OR=2.6543）,手术时间长（OR=2.874）.结论 PGS发生与多种因素有关,应通过围手术期控制血糖,提高血清白蛋白,条件允许的情况下尽量采取毕I式胃肠吻合,尽量缩短手术时间来预防和减少PGS发生.
Objective To examine the relevant factors contributing to the development of postsurgical gastroparesis（PSG）. Methods A total of 280 patients who underwent subtotal gastrectomy in our hospital from Jan. 2002 to Jun. 2009 were enrolled in the study. The patients who developed PGS were assigned to the observant group and those without PGS to the control group. The possible factors that affected the development of PGS were analyzed by one - way analysis of variance and logistic regression analysis. Results Among the patients, 20 developed PGS. One - way analysis of variance showed that PGS- related factors included old age, hyperglycemia during perioperative period, anemia, hypoproteine- mia,preoperative gastrointestinal obstruction, preoperative non - enteral nutrition, Biliroth 1] operation, prolonged operation time, extensive lymphadenectomy,large amount of hemorrhage during operation, appli- cation of patient - controlled analgesia, intra - abdominal infection and late postoperative enteral nutrition （ P 〈 0.05 ）. The occurrence of PGS failed to be associated with gender（ P 〉 0.05 ）. Non - condition multi- variate analysis showed 4 risk factors including hyperglycemia during perioperative period （OR = 3. 123 ）, hypoproteinemia （ OR = 3. 098 ）, Biliroth Ⅱ operation （ OR = 9. 6543 ） and prolonged operation time （ OR = 2. 874）. Conclusion Some steps should be taken to prevent and reduce the occurrence of PGS, including blood sugar control during perioperative period, increase in the level of albumin, use of Biliroth I gastroenterostomy and shortening of operation time.
出处
《临床外科杂志》
2010年第7期459-461,共3页
Journal of Clinical Surgery
