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肠皮肤瘘患者腹腔内出血的危险因素及预后

Risk factor and outcome for intra-abdominal bleeding in patients with enterocutaneous fistula.

作者信息

Wu Lei, Ren Jianan, Liu Qinjie, Wang Gefei, Wu Xiuwen, Gu Guosheng, Li Guanwei, Guo Kun, Hong Zhiwu, Hu Qiongyuan, Ren Huajian, Li Jieshou

机构信息

Department of General Surgery, Jinling Hospital, Medical School of Nanjing University Department of General Surgery, Jinling Hospital, Nanjing Medical University Medical School of Southeast University, Nanjing, China.

出版信息

Medicine (Baltimore). 2016 Nov;95(47):e5369. doi: 10.1097/MD.0000000000005369.

Abstract

Intra-abdominal bleeding is a major and lethal complication in patients with enterocutaneous fistula (ECF) while few studies are involved in this aspect. In the present study, we aimed to investigate the risk factors and assessed the outcome for intra-abdominal bleeding in patients with ECF.A retrospective study was performed from October 2013 to October 2015. Medical records of 67 ECF patients with intra-abdominal bleeding and 134 ECF patients without intra-abdominal bleeding matched as controls were reviewed and analyzed. Logistic regression was performed to evaluate the risk factor of intra-abdominal bleeding in patients with ECF. Outcomes such as mortality, hospital durations, and cost were compared between ECF patients with or without intra-abdominal bleeding.A total of 67 ECF patients suffered intra-abdominal bleeding during hospitalization. In the logistic regression, duodenum fistula (odds ratio [OR]: 3.899, 95% confidence interval [CI]: 1.204-12.634, P = 0.023), hemorrhage history (OR: 15.846 95% CI: 5.779-43.448, P < 0.001), and acute kidney injury (OR: 6.350 95% CI: 2.033-19.836, P = 0.001) were independent risk factors for intra-abdominal bleeding in patients with ECF. In addition, the bleeding patients showed a significantly higher mortality rate, prolonged total parenteral nutrition days, hospital and intensive care unit durations, more complications, and increased cost.We revealed the 3 risk factors for intra-abdominal bleeding among ECF patients. Besides, intra-abdominal hemorrhage was associated with a poor prognosis in patients with ECF.

摘要

腹腔内出血是肠外瘘(ECF)患者的一种主要且致命的并发症,然而这方面的研究较少。在本研究中,我们旨在调查ECF患者腹腔内出血的危险因素并评估其结局。

我们进行了一项回顾性研究,时间跨度为2013年10月至2015年10月。回顾并分析了67例发生腹腔内出血的ECF患者以及134例未发生腹腔内出血的ECF患者作为对照的病历。采用逻辑回归分析评估ECF患者腹腔内出血的危险因素。比较了发生或未发生腹腔内出血的ECF患者的死亡率、住院时间和费用等结局。

共有67例ECF患者在住院期间发生腹腔内出血。在逻辑回归分析中,十二指肠瘘(比值比[OR]:3.899,95%置信区间[CI]:1.204 - 12.634,P = 0.023)、出血史(OR:15.846,95%CI:5.779 - 43.448,P < 0.001)和急性肾损伤(OR:6.350,95%CI:2.033 - 19.836,P = 0.001)是ECF患者腹腔内出血的独立危险因素。此外,出血患者的死亡率显著更高,全胃肠外营养天数、住院和重症监护病房时间延长,并发症更多,费用增加。

我们揭示了ECF患者腹腔内出血的3个危险因素。此外,腹腔内出血与ECF患者的不良预后相关。

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