经皮透视下胃造瘘术后出血风险因素回顾性分析

目的：探讨X线引导经皮胃造瘘(Percutaneous fluoroscopical gastrostomy, PFG)术后出血的发生率，并评价与术后出血相关的风险因素。方法：回顾性分析我院2015年10月至2019年12月221名住院行X线引导经皮胃造瘘术的临床资料，记录患者的性别、年龄、病因、营养状态、术前胃位置、穿刺外口与内口部位、胃壁固定松紧度、术后是否明胶海绵加压包扎及术者手术经验，应用IBM SPSS 23对上述出血风险因素分别进行单因素与多因素分析。结果：221例患者中有32例发生术后瘘口渗血，发生率为15.2%。单因素分析不同的病因、术前营养不良状态、术前胃位置、穿刺外口位置及胃壁固定松紧度术后出血差异有统计学显著意义。多因素Logistic回归分析显示运动神经元病、术前严重营养不良状态、术前胃腔位置偏高或偏后、穿刺入路穿越腹直肌及胃壁固定偏松者是术后出血主要风险因素。结论：运动神经元病、严重营养不良以及选择穿越腹直肌穿刺是PFG术后出血的独立风险因素，早期及时行PFG,术前谨慎评估出血风险并制定相应的手术预案可减少术后出血的发生。

The risk factors for bleeding after percutaneous fluoroscopic gastrostomy: a retrospective analysis

Objective To investigate the rate of post- percutaneous fluoroscopical gastrostomy(PFG) and to evaluate the clinical risk factors for PFG. Methods Retrospective analysis of the clinical data of 221 hospitalized PFG from October 2015 to December 2019, recording the patient''s sex, age, etiology, nutritional status, preoperative stomach position, punctured outer and inner mouth, gastric wall retention splination, postoperative gelatin sponge pressurized bandage and percutaneous puncture experience, The IBM SPSS 23 is used to analyze the bleeding risk factors for the above factors, respectively. Results In 32 of the 221 patients, the incidence of bleeding after PFG was 15.2%. The single-factor analysis of different etiology, preoperative malnutrition, preoperative stomach position, puncture dysentery position and postoperative bleeding differences after gastric wall fixed slackness were statistically significant. The multi-factor Logistic regression analysis showed that motor neuron disease, severe preoperative malnutrition, mid-rectus abdominis puncture were the main risk factors for postoperative bleeding. Conclusion Motor neurone disease, severe malnutrition and choice to cross the mid-rectus abdominis puncture are independent risk factors for postoperative bleeding after PFG, early and timely PFG, careful preoperative assessment of bleeding risk and development of appropriate surgical plans can reduce the occurrence of postoperative bleeding.