成年机械性肠梗阻患者治疗结局的预测因素

Predictive factors of management outcome in adult patients with mechanical intestinal obstruction.

作者信息

Bankole Adebambo Olalekan, Osinowo Adedapo Olumide, Adesanya Adedoyin Adekunle

机构信息

Department of Surgery, General Surgery Unit, College of Medicine, Lagos University Teaching Hospital, University of Lagos, Lagos, Nigeria.

出版信息

Niger Postgrad Med J. 2017 Oct-Dec;24(4):217-223. doi: 10.4103/npmj.npmj_143_17.

DOI:10.4103/npmj.npmj_143_17

PMID:29355160

Abstract

BACKGROUND

Mechanical intestinal obstruction (MIO) is a common and potentially fatal surgical emergency, which constitutes about 20% of all admissions to the surgical emergency departments.

OBJECTIVE

To determine the predictive factors of morbidity and mortality in patients undergoing treatment for MIO at our tertiary hospital.

PATIENTS AND METHODS

This was a prospective study of consecutive patients, 18 years and above, that presented with features of MIO during a 1-year period (May 2014 to April 2015). Each patient had resuscitation, comprehensive clinical evaluation, appropriate investigations and definitive treatment. The data were analysed using SPSS version 22.

RESULTS

One hundred and five patients were studied. The age range was 18-86 years with a mean (standard deviation) of 45.6 (14.8) years. There were 54 males with a male to female ratio of 1.1-1. The common causes of MIO were post-operative adhesion (48.6%), tumour (25.7%), external hernia (15.2%) and volvulus (5.7%). Eighty-four patients (80%) had operative intervention while 21 patients (20%) had conservative management. Univariate analysis showed that dehydration, tachycardia (>90 bpm), pyrexia, abnormal levels of potassium, urea and creatinine, leucocytosis, American Society of Anesthesiologists (ASA) status >IIIE, bowel resection, intraoperative blood loss >500 ml and duration of surgery >2 h were significant predictors of mortality (P < 0.05). Multivariate analysis showed that elevated serum urea at hospital presentation and ASA status greater than IIIE were the independent predictors of mortality, but none of the factors could independently predict morbidity. The most common post-operative complication and cause of death were wound infection (29.6%) and sepsis (66.7%). The mortality rate was 14.3%.

CONCLUSION

The most common cause of MIO was post-operative adhesion. Elevated serum urea and ASA status greater than IIIE were the independent predictors of mortality.

摘要

背景

机械性肠梗阻（MIO）是一种常见且可能致命的外科急症，约占外科急诊入院患者的20%。

目的

确定在我们三级医院接受MIO治疗患者的发病和死亡预测因素。

患者与方法

这是一项对连续1年期间（2014年5月至2015年4月）出现MIO特征的18岁及以上患者的前瞻性研究。每位患者均接受复苏、全面临床评估、适当检查及确定性治疗。数据采用SPSS 22版进行分析。

结果

共研究了105例患者。年龄范围为18 - 86岁，平均（标准差）为45.6（14.8）岁。男性54例，男女比例为1.1 - 1。MIO的常见病因是术后粘连（48.6%）、肿瘤（25.7%）、外部疝（15.2%）和肠扭转（5.7%）。84例患者（80%）接受了手术干预，21例患者（20%）接受了保守治疗。单因素分析显示，脱水、心动过速（>90次/分钟）、发热、血钾、尿素和肌酐水平异常、白细胞增多、美国麻醉医师协会（ASA）状态>IIIE、肠切除、术中失血>500 ml及手术时间>2小时是死亡的显著预测因素（P < 0.05）。多因素分析显示，入院时血清尿素升高和ASA状态大于IIIE是死亡的独立预测因素，但没有一个因素能独立预测发病情况。最常见的术后并发症和死亡原因是伤口感染（29.6%）和脓毒症（66.7%）。死亡率为14.3%。