胃癌根治性胃大部切除术后继发性肠梗阻的危险因素分析及护理对策

摘要

Objective:To investigate the risk factors and prevention measures of secondary intestinal obstruction after prostatectomy gastric cancer radical gastrectomy.Method:471 cases of gastric cancer after radical gastrectomy in Shandong Tengzhou City workers Hospital from January 2007 to December 2013 were made retrospective analysis, including 35 cases of postoperative secondary intestinal obstruction(SIO).The secondary obstruction were selected as the dependent variable,the 17 related indicators were selected for independent variables,the non conditional Logistic regression were analyzed.Result:The results of multiple Logistic regression analysis showed:preoperative pyloric obstruction, mental tension, intraoperative Billroth II Shi Wenhe, intraoperative lymph node dissection(D3), postoperative analgesia pump after operation, blood glucose level, enteral nutrition in postoperative time,postoperative abdominal infection,anastomotic fistula were SIO risk factors(OR>1,P<0.05),peri operation period the level of hemoglobin and total protein level were the protective factor of SIO occurrence(OR<1,P<0.05).Conclusion:The SIO occurrence of gastric cancer gastrectomy has many related factors , the treatment actively job related risk factors has important significance on the treatment effect of SIO.%目的：探讨根治性胃大部切除术后发生继发性肠梗阻的危险因素及防治措施。方法：回顾性分析山东省滕州市工人医院2007年1月-2013年12月471例行胃癌根治性胃大部切除术患者的临床资料，其中35例发生术后继发性肠梗阻（SIO）；以是否发生继发性肠梗阻为因变量，以选取的17项相关指标为自变量，进行非条件Logistic回归分析。结果：术前合并幽门梗阻、精神紧张、术中毕Ⅱ式吻合、术中淋巴结清扫范围（D3）、术后使用镇痛泵、术后血糖水平、术后肠内营养开始时间、术后腹腔感染、术后吻合口瘘是术后发生继发性肠梗阻的危险因素（OR>1，P<0.05），围手术期的血红蛋白水平与总蛋白水平是术后发生继发性肠梗阻的保护因素（OR<1，P<0.05）。结论：胃癌根治性胃大部切除术后发生继发性肠梗阻与许多危险因素相关，针对危险因素做出积极的防治工作，对提高治疗水平具体重要意义。