摘要
目的探究腹腔镜上消化道穿孔修补术后感染影响因素及白介素6(IL-6)、高敏C反应蛋白(hs-CRP)、前白蛋白(PA)、自然杀伤(NK)细胞水平变化。方法以2015年3月-2019年2月天津市北辰区中医医院收治的110例行腹腔镜上消化道穿孔修补术治疗的上消化道穿孔患者为研究对象。回顾性收集其一般资料、感染情况、血清细胞因子水平等临床资料,观察术后感染发生情况,并通过多因素Logistic回归分析对腹腔镜上消化道穿孔修补术后感染影响因素进行分析。结果 110例上消化道穿孔术后发生感染的患者有31例,感染率为28.18%。感染患者IL-6、hs-CRP均高于非感染患者,NK细胞、血清PA水平低于非感染患者(P<0.05)。多因素Logistic回归分析结果显示,术后镇痛、硬膜外麻醉均为腹腔镜上消化道穿孔修补术后感染的独立保护因素(P<0.05),肺部慢性疾病、术前存在休克、胃肠减压时间>48 h均为腹腔镜上消化道穿孔修补术后感染的独立危险因素(P<0.05)。结论消化道穿孔修补术患者发生术后感染的危险因素较多,临床可针对性观察并及时进行干预,IL-6、hs-CRP、NK细胞、PA水平变化可能作为预测因素。
OBJECTIVE To investigate the risk factors for infection and the variation levels of IL-6(IL-6), high-sensitivity C-reactive protein(hs-CRP) and prealbumin(PA), natural killing(NK) cells after laparoscopic upper gastrointestinal perforation repair surgery. METHODS Total of 110 patients with upper gastrointestinal perforation treated by laparoscopy in the department of surgery of traditional Chinese Medicine hospital during Mar. 2015 to Feb. 2019 were enrolled in this study. The clinical data included general information, infection status, serum cytokine levels were collected retrospectively, the incidence of postoperative infection was observed, and the risk factors of infection after laparoscopic upper gastrointestinal perforation repair were analyzed by multi-factor Logistic regression analysis. RESULTS Thirty-one of 110 patients with upper gastrointestinal perforation had infection after operation, the infection rate was 28.18%. The levels of IL-6 and hs-CRP in infected patients was higher than those in non-infected patients, and the level of NK cells, prealbumin(PA) in the infected patients was significantly lower than that in the non-infected patients(P<0.05). Multi-factor Logistic regression analysis showed that postoperative analgesia and epidural anesthesia were the protective factors for infection after laparoscopic upper gastrointestinal perforation repair(P<0.05);chronic pulmonary diseases, shock before operation, gastrointestinal decompression time >48 h were independent risk factors for infection after laparoscopic upper gastrointestinal perforation repair(P<0.05). CONCLUSION There are many risk factors for postoperative infection in patients undergoing digestive tract perforation repair, and clinical observation and timely intervention can be targeted. Changes in IL-6, HS-CRP, NK cells and PA levels may be used as predictors.
作者
刘红彬
何基安
邢文超
王永新
王双辉
LIU Hong-bin;HE Ji-an;XING Wen-chao;WANG Yong-xin;WANG Shuang-hui(Traditional Chinese Medicine Hospital,Beichen District,Tianjin 300400,China)
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2021年第7期1043-1046,共4页
Chinese Journal of Nosocomiology
基金
天津市教育委员会科技发展基金资助项目(20130207)。
关键词
上消化道穿孔
腹腔镜上消化道穿孔修补术
白介素-6
高敏C-反应蛋白
前白蛋白
自然杀伤细胞
危险因素
Upper gastrointestinal perforation
Laparoscopic repair of upper gastrointestinal perforation
IL-6
Highly sensitive C-reactive protein
Prealbumin
Natural killer cells
Risk factors
