自闭保护性回肠插管造口患者并发堵管性肠梗阻的危险因素研究

目的分析自闭保护性回肠插管造口患者发生堵管性肠梗阻的危险因素,为临床护理提供依据。方法采用病例对照研究设计,将2015年1月—2019年10月在浙江省某三级甲等医院行自闭保护性回肠插管造口术发生堵管性肠梗阻的45例患者作为病例组,从同一时期、同一科室、相同手术而未发生堵管性肠梗阻的324例中随机抽取180例(1∶4)作为对照组,比较两组的一般资料、体重指数、合并疾病、实验室相关指标、手术情况、回肠插管造口维护情况等,采用Logistic回归分析获取堵管性肠梗阻的危险因素。结果 Logistic回归分析显示,体重指数(OR=2.123)、术后腹腔感染(OR=11.119)、拔管时间(OR=0.193)、每周随访插管维护(OR=24.121)是自闭保护性回肠插管造口患者并发堵管性肠梗阻的独立危险因素。结论为预防堵管性肠梗阻的发生,临床需积极控制术后腹腔感染和尽早拔除插管,超重患者应重视回肠插管造口的冲洗,鼓励患者按计划随访。

Risk factors of obstructive intestinal obstruction among patients with ileal spontaneously closed intubation stoma

Objective By analyzing the cases of intestinal obstruction caused by the blockage of protective ileal intubation,this study aims to conclude experience and novel guidance for the further clinical nursing.Methods In this retrospective case-control study design,45 patients with intestinal obstruction due to the block of protective ileal intubation were included in the cases group,and 180 patients（1 : 4） were randomly selected from the 324 patients who received the same operation without intestinal obstruction as the control group. All the patients were treated in the First Affiliated Hospital of Zhejiang University School of Medicine from January 2015 to October 2019. The general information,BMI（body mass index）,comorbidities,relative laboratories results,perioperative situations,the frequency of intubation care were analyzed using logistic regression to investigate the risk factors. Results Results indicated that body mass index（OR=2.123）,postoperative abdominal infection（OR=11.119）,extubation time（OR=0.193）,and weekly follow-up intubation maintenance（OR=24.121） were the independent risk factors. Conclusion In order to prevent the occurrence of intestinal obstruction after ileal intubation,the control of postoperative infection and shorter exintubation time plays a key role in the recovering process. Regular and high quality intubation care is also necessary to the patients,especially to the overweight cases.