急性阑尾炎患者穿孔的发病率及其危险因素研究

摘要

Objective To explore the prevalence of perforation in patients with acute appendicitis and its risk factors . Methods We enrolled 330 patients with acute appendicitis who received surgical treatment in the Department of General Surgery of Mingguang People′s Hospital from 2011 to 2014.According to the results of pathological diagnosis after surgery , the subjects were divided into perforation group and non perforation group .We recorded the course of disease , length of hospital stay before surgery, time from onset to surgery , the highest temperature before surgery , preoperative pulse , preoperative blood pressure , findings during operation and the results of pathological examination after surgery .By blood routine examination and urine routine test, we recorded a series of indicators including WBC , NCP, LCP, LAC, RBC, HGB, HCT and all the indicators in urine routine test.Logistic regression analysis was conducted to determine the risk factors for perforation in patients with acute appendicitis.Results Among the 330 subjects, perforation occurred in 69 subjects, with a prevalence rate of 20.9%.The prevalence rates of male subjects and female subjects were 23.6%and 17.6%, and no significance existed between them (χ2 =1.812, P=0.178).The prevalence rates for patients with the age ranges of ≤44, 45-59 and ≥60 were 22.8%, 15.0%and 17.2%, and no significant differences existed among them (χ2 =2.036, P =0.361).Perforation group and non perforation group were significantly different ( P <0.05 ) in the highest temperature before surgery , preoperative pulse , preoperative breath , WBC, NCP, LCP, LAC and abnormal urine routine results .The multivariate Logistic regression analysis showed that the highest temperature before surgery , preoperative pulse and LCP were risk factors ( P<0.05 ) for perforation in patients with acute appendicitis.Through the test of Hosmer -Lemeshow, we found the predictive accuracy rate of the Logistic model was 79.1%. Conclusion The prevalence of perforation in inpatients with acute appendicitis is 1/5.The highest temperature before surgery , preoperative pulse and LCP are risk factors .LCP is a risk factor newly included in Logistic regression model, which is closely correlated with perforation and helpful for the prediction of perforation .%目的：探索急性阑尾炎患者穿孔的发病率及其相关危险因素。方法选取2011—2014年明光市人民医院普外科手术治疗的急性阑尾炎患者330例，依据术后病理诊断结果将患者分为穿孔组和无穿孔组。记录患者病程、术前住院时间、发病至手术时间、术前最高体温、术前脉搏、术前呼吸频率、术前血压、术中所见、术后病理检查结果；记录实验室血常规、尿常规的检测结果，记录项目：白细胞计数（ WBC）、中性粒细胞分数（ NCP）、淋巴细胞分数（LCP）、淋巴细胞绝对数（LAC）、红细胞计数（RBC）、血红蛋白（HGB）、血细胞比容（HCT）、尿常规全部项目。采用Logistic回归分析影响急性阑尾炎患者发生穿孔的危险因素。结果330例患者中穿孔69例，发病率为20.9％。男性穿孔发病率为23.6％，女性穿孔发病率为17.6％，两者比较，差异无统计学意义（χ2＝1.812， P＝0.178）。≤44岁、45～59岁、≥60岁者穿孔发病率分别为22.8％、15.0％、17.2％，3者比较，差异无统计学意义（χ2＝2.036， P＝0.361）。穿孔组与无穿孔组术前最高体温、术前脉搏、术前呼吸频率、 WBC、 NCP、 LCP、 LAC、尿常规异常比较，差异均有统计学意义（P＜0.05）。多因素Logistic回归分析结果显示，术前最高体温、术前脉搏、 LCP是急性阑尾炎发生穿孔的危险因素（P＜0.05）。模型经Hosmer-Lemeshow检验（χ2＝0.405， P＝0.939），预测正确率为79.1％。结论住院患者急性阑尾炎穿孔发病率约为1／5，术前最高体温、术前脉搏和LCP是影响阑尾炎患者发生穿孔的因素，其中LCP作为与穿孔密切关联的新因素纳入Logistic回归模型，有助于穿孔预测。