摘要
目的探讨粘连性肠梗阻手术指征的多因素预测方法。方法回顾性分析安徽医科大学第一附属医院普外科1996年1月至2010年1月期间住院的2034例粘连性肠梗阻患者(进入分析模型有1992例),利用logistic多因素回归分析法,将可能影响粘连性肠梗阻急诊手术指征的17项因素〔梗阻持续时间、发作次数、腹部手术史、持续或剧烈腹痛、剧烈或频繁呕吐、严重腹胀、便血、发热、心率、休克或低血压、触及肿大肠襻、肠鸣音减弱、腹膜炎、外周血白细胞(WBC)计数、腹部立位X线平片示梗阻肠襻固定且扩张加重、腹腔游离气体及B超提示腹腔积液〕进行logistic回归分析,根据logistic回归分析理论得出粘连性肠梗阻需急诊手术几率的预测公式。结果根据logistic多因素及逐步回归分析得出梗阻持续时间、第一次发作、出现持续或剧烈腹痛、临床体检发现心率增快、出现腹膜炎体征、腹部立位X线平片见梗阻肠襻固定且扩张加重、B超提示腹腔积液及外周血WBC计数增高8项指标可以预测粘连性肠梗阻患者是否需急诊手术。其预测公式为:logit(P)=expZ/(1+expZ),其中Z={-7.813+〔-1.942×X1(1)/2.290×X1(2)/2.765×X1(3)〕+2.801×X2+2.692×X4+10.610×X9(1)/13.279×X9(2)+3.422×X13+〔-3.048×X14(1)/16.992×X14(2)〕+6.113×X15+2×X17},式中:X1(1)=梗阻持续时间3～5d,X1(2)=梗阻持续时间5～7d,X1(3)=梗阻持续时间≥7d;X2=发作次数;X4=持续或剧烈腹痛;X9(1)=心率60～100次/min,X9(2)=心率≥100次/min;X13=腹膜炎;X14(1)=WBC计数(10～20)×109/L,X14(2)=WBC计数≥20×109/L;X15=腹部立位X线平片示梗阻肠襻固定且扩张加重;X17=B超示腹腔积液。P>0.5时则需急诊手术。本组结果符合率为99.00%,敏感性为96.17%,特异性为99.53%。随后利用2010年1月至2010年4月期间收治的粘连性肠梗阻患者105例对上述预测公式进行评价,符合率为96.20%,敏感性为90.00%,特异性为96.84%。结论预测公式有较好的实用价值,公式中各项系数还可随病例数增加进行修正。
Objective To approach the convenient prediction methods about surgical indications of adhesive ileus. Methods Two thousand and thirty-four patients with adhesive ileus were analyzed retrospectively between January 1996 and January 2010 in the Department of General Surgery,The First Affiliated Hospital of Anhui Medical University,and 1 992 patients were included into this model. Seventeen factors which could influence the surgical decisions,including period of intestinal obstruction （X1）,frequency of attack （X2）,history of operation on abdominal region （X3）,continuous and severe abdominal pain （X4）,severe or frequent vomiting （X5）,severe abdominal distention （X6）,hemafecia （X7）,fever （X8）,heart rate （X9）,shock or hypotension （X10）,touching a swell ansa intestinalis （X11）,hypoactive bowel sound （X12）,peritonitis （X13）,white blood cell （WBC） count of peripheral blood （X14）,obstruction ansa interstinalis fixation and a severe expansion by abdominal erect position plain film （X15）,peritoneal cavity free air （X16）,and seroperitoneum whether or not by B ultrasonic examination （X17） were analyzed by binary logistic regression. Then prediction schedule whether patients with adhesive ileus needed emergency operation was gained by the theory of logistic regression analysis. Results Eight items were included in the prediction model by the method of forward stepwise which were X1,X2,X4,X9,X13,X14,X15,and X17,respectively. The probability of operation could be calculated by the following formula：logit（P）=expZ/（1＋expZ）,where,Z={-7.813＋〔-1.942×X1（1）/2.290×X1（2）/2.765×X1（3）〕＋2.801×X2＋2.692×X4＋10.610×X9（1）/13.279×X9（2）＋3.422×X13＋〔-3.048×X14（1）/16.992×X14（2）〕＋6.113×X15＋2×X17},which X1（1）,X1（2）,and X1（3） were periods of intestinal obstruction 3-5 d,5-7 d,and ≥7 d,respectively. X9（1） and X9（2） were heart rates of 60-100/min and ≥100/min,respectively. X14（1） and X14（2） were WBC counts of peripheral blood of （10-20）×109/L and ≥20×109/L,respectively. The patient had to accept surgical procedure when the value of P was more than 0.5. The coincidence was 99.00%,sensitivity was 96.17%,specificity was 99.53% in 1 992 patients. The coincidence was 96.20%,sensitivity was 90.00%,specificity was 96.84% in 105 patients between January 2010 and April 2010 in this hospital. Conclusion The prediction schedule is a good useful value,but the coefficients is corrected following the cases increasing.
出处
《中国普外基础与临床杂志》
CAS
2010年第9期939-943,共5页
Chinese Journal of Bases and Clinics In General Surgery
