绞窄性肠梗阻与全身炎性反应综合征相关性分析VIP专享VIP免费

消化外科�2005年第4卷第4期255-257JournalofDigestiveSurgery,2005,4(4):255-257文章编号:1671-4555(2005)04-0255-03�临床研究�绞窄性肠梗阻与全身炎性反应综合征相关性分析李瑾�张雪峰�王希泽�李永双�金红旭�宗修锟��摘要!�目的�探讨绞窄性肠梗阻与全身炎性反应综合征(SIRS)的关系。方法�回顾性分析42例肠梗阻手术病人的临床资料。结果�SIRS诊断绞窄性肠梗阻的敏感性为81.8%;特异性为85%。SIRS判断肠坏死的敏感性为95.2%;特异性为76.2%。绞窄性肠梗阻患者的白细胞明显高于单纯肠梗阻[(12.3∀3.6)#109/L对(8.5∀3.6)#109/L,P=0.242],心率也明显升高[(106.1∀21.2)次/分对(82.3∀15.1)次/分,P=0.0137]。肠坏死者的白细胞明显高于无肠坏死者[(13.4∀2.9)#109/L对(9.0∀2.0)#109/L,P=0.0162]。SIRS阳性者坏死肠段明显长于SIRS阴性者[(86.24∀22.3)cm对5.8cm,P=0.0049]。结论�SIRS能够提示肠梗阻出现肠绞窄。��关键词!�肠梗阻��全身炎性反应综合征��中图法分类号!�R574.2����文献标识码!�AThecorrelationbetweenstrangulatedintestinalobstructionandsystemicinflammatoryresponsesyndrome(SIRS)�LiJin,ZhangXuefeng,WangXize,LiYongshuang,JinHongxu,ZongXiukun.DepartmentofGeneralSurgery,GeneralHospitalofShenyangMilitaryRegion,Shenyang110016,China��Abstract!�Objective�Toinvestigatethecorrelationbetweenstrangulatedintestinalobstructionandsystemicinflammatoryresponsesyndrome(SIRS).Methods�Theclinicaldataof42patientswithintestinalobstructionundergoingoperationwereanalyzedretrospectively.Results�ThesensitivityofSIRSinthediagnosisofstrangulatedintestinalobstructionwas81.8%,andthespecificitywas85%(P<0.005).ThesensitivityofSIRSinthediagnosisofintestinalnecrosiswas95.2%,andthespeci�ficitywas76.2%(P<0.005).Whitebloodcellcountswassignificantlyhigherinpatientswithstrangulatedintestinalobstructionthaninthosewithsimpleobstruction[(12.3∀3.6)#109/Lvs(8.5∀3.6)#109/L,P=0.0242].Theheartratewassignificantlyhigherinpatientswithstrangulationobstructionthaninthosewithsimpleobstruction[(106.1∀21.2)beats/minvs(82.3∀15.1)beats/min,P=0.0137].Whitebloodcellcountswassignificantlyhigherinpatientswithintestinalnecrosisthaninthosewithoutintestinenecrosis[(13.4∀2.9)#109/Lvs(9.0∀2.0)#109/L,P=0.0162].ThenecroticintestineinpatientswithSIRSwassignficantlylongerthanthosewithoutSIRS[(86.4∀22.3)cmvs5.8cm,P=0.0049].Conclusions�TheresultssuggestthatSIRSshouldbeusedoftheasignforstrangulatedintestinalobstruction.��Keywords!�intestinalobstruction��systemicinflammatoryresponsesyndrome(SIRS)��绞窄性肠梗阻应立即手术治疗,延误诊断可以导致腹膜炎、脓毒血症甚至多脏器功能衰竭。因此,肠绞窄的早期诊断非常重要。全身炎症反应综合征(SIRS)被认为是许多疾病的早期表现[1]。本研究对42例肠梗阻手术病人的临床资料进行回顾性分析,探讨绞窄性肠梗阻与SIRS的关系。�作者单位:110016沈阳军区总医院普外科1�资料和方法��选择我院1992年2月至2003年5月手术治疗肠梗阻病人42例,男26例,女16例,年龄13~82岁。其中绞窄性肠梗阻22例,单纯性肠梗阻20例。分析SIRS阳性率及SIRS因素与肠绞窄和肠坏死的关系。结果采用t检验和�2检验。�255�2�结果��22例绞窄性肠梗阻有18例术前表现为SIRS,20例单纯性肠梗阻中只有3例表现为SIRS。SIRS诊断肠绞窄的敏感性为81.8%;特异性为85%(P<0.005),见表1。表1�SIRS阳性率SIRS(阳性)SIRS(阴性)绞窄性肠梗阻(n=22)18(81.8%)4(18.2%)单纯性肠梗阻(n=20)3(15.0%)17(85.0%)��两组比较P<0.005。��21例SIRS阳性的患者中有16例出现肠坏死(76.2%),21例SIRS阴性有1例出现肠坏死(4.8%),SIRS判断肠坏死的敏感性为95.2%,特异性为76.2%(P<0.005),见表2。表2�SIRS与肠坏死的关系坏死无坏死SIRS(阳性)16(76.2%)5(23.8%)SIRS(阴性)1(4.8%...