贲门癌切除术后围术期死亡原因分析及术后并发症logistic回归分析及风险预测模型的建立
Guangdong Medical Journal（2017）
Abstract
目的 探讨并分析贲门癌围术期死亡原因及术后并发症危险因素,建立logistics回归模型.方法 收集305例贲门癌切除术患者的临床资料,根据围术期及住院期间术后有无发生并发症分为两组,将33个可能对贲门癌术后发生并发症有相关影响的有代表性的因素进行回顾性分析,通过计算机用logistic回归模型分析术后并发症相关危险因素,进行单因素、多因素、相关性及共线性检验分析,并建立风险预测模型,总结实际意义.结果 305例贲门癌中手术死亡7例,手术死亡率2.3%.死亡原因:循环系统并发症2例(包括心源性休克并急性冠脉综合征1例,心源性猝死1例,占死亡组的28.60%), 呼吸系统并发症 2例 (包括肺部感染、重症肺炎、肺不张等引起的呼吸衰竭2例,占死亡组的28.60%),呼吸系统与循环系统并发症并存3例(包括呼吸循环衰竭2例,呼吸衰竭并心肌梗死1例,占死亡组的42.80%),吻合口瘘1例(14.30%),乳糜胸1例(14.30%).单因素logistic回归分析显示,在所分析的33个因素中,有9个因素与贲门癌切除术后发生并发症有关,分别为术前合并心脏病、病变部位、手术时长、手术切除范围、手术年代、术中输血、术中出血量、肠内营养时间、重症监护室(ICU)治疗时间,差异有统计学意义(P<0.05).多因素logistic回归分析提示:术前合并心脏病、手术切除范围、术中输血、肠内营养时间等指标有统计学意义(P<0.05),术前合并心脏病为独立危险因素,术中输血为保护因素,并进入logistic回归方程,获得预测模型P=1/(1+e(18.256-1.079X33+0.963X19-0.788X26+0.725X30)).结论 合并心脏病的贲门癌患者手术评估需严格掌握,欲防止并发症发生,围术期需注意心功能的动态变化,保证心功能能够维持机体正常生理功能;手术切除范围愈大,术后并发症发生风险愈高,故术中应根据病变部位和范围在切除病变的前提下尽可能减少创伤,有助于减少术后并发症的发生;贲门癌手术创伤较大,术中予输血有助于术后减少术后并发症发生;肠内营养时间的合理性与科学性能影响围术期并发症发生率,故需结合具体病情开始肠内营养时间并需动态观察营养前后机体的变化.
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