摘要
目的探讨成人门静脉积气(PVG)死亡的危险因素,总结诊治要点。方法以“门静脉气体”“portal venous gas”为关键词在CNKI、PubMed数据库中检索2013-2022年报道的成人PVG文献,对符合纳入标准的134例和安庆市立医院普外科2022年收治的3例共计137例成人PVG的一般情况、基础疾病、体检结果、实验室检查数据进行统计,以死亡结局进行单因素和多因素的Logistic回归分析。结果137例PVG患者中死亡40例(死亡组),病死率为29.2%。单因素分析显示,死亡组与未死亡组(n=97)在是否手术治疗、病因是否为肠缺血坏死、是否合并有高血压、心率和舒张压方面差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,手术治疗(OR=0.225,95%CI 0.075-0.674,P=0.008)是成人PVG死亡的保护因素,肠缺血坏死(OR=5.947,95%CI 2.187-16.171,P<0.001)、高血压(OR=3.238,95%CI 1.209-8.674,P=0.019)、心率增快(OR=1.032,95%CI 1.013-1.052,P=0.001)是成人PVG死亡的独立危险因素。心率这一指标的受试者工作特征(ROC)曲线下面积(AUC)为0.708(95%CI 0.604-0.812),截断(cut-off)值为117.5次/min,此时灵敏度为0.625,特异度为0.763,约登系数为0.388。结论为降低成人PVG的病死率,诊治时应了解患者合并基础疾病(尤其是高血压)情况,判断其早期是否出现休克,病因是否为肠缺血坏死,并根据不同病因尽快决定是否行手术治疗。
Objective To identify the risk factors associated with mortality among adults diagnosed with portal venous gas(PVG),and summarize the key point in diagnosis and treatment of PVG.Methods Using“portal venous gas”as the key words,a search was conducted in CNKI and PubMed databases for adult PVG literature reported from 2013 to 2022.A total of 137 cases of adult PVG,including 134 cases that met the inclusion criteria and 3 cases treated in Anqing Municipal Hospital in 2022,were analyzed for demographic features,comorbidities,physical examination results,and laboratory data.Univariate and multivariate Logistic regression analysis were performed with death outcome.Results Of the 137 adult patients with PVG included in the study,40 cases died,resulting in a mortality rate of 29.2%.Univariate analysis revealed statistical significant differences(P<0.05)between the death group and the survival group(n=97)in terms of surgery status,intestinal ischemic necrosis as the cause of PVG,hypertension presence,heart rate and diastolic blood pressure.Multivariate logistic regression analysis showed that surgery(OR=0.225,95%CI 0.075-0.674,P=0.008)was a protective factor for mortality in adults with PVG,whereas intestinal ischemic necrosis(OR=5.947,95%CI 2.187-16.171,P<0.001),hypertension(OR=3.23,95%CI 1.209-8.674,P=0.019)and increased heart rate(OR=1.032,95%CI 1.013-1.052,P=0.001)were independent risk factors for mortality in adults with PVG.Additionally,the receiver operating characteristic(ROC)curve analysis of heart rate indicated an area under the curve(AUC)of 0.708(95%CI 0.604-0.812).The cut-off value of 117.5 beats per minute had a sensitivity of 0.625 and a specificity of 0.763,along with a Youden’s index of 0.388.Conclusion To reduce mortality in adult patients with PVG,it is crucial to evaluate the presence of comorbidities,particularly hypertension,and to monitor for early onset of shock and intestinal ischemic necrosis as potential cause,timely decision-making regarding surgical intervention is also necessary based on the specific etiology of PVG.
作者
凌新建
王永胜
潘书鸿
LING Xinjian;WANG Yongsheng;PAN Shuhong(Department of General Surgery,Anqing Municipal Hospital,Anqing,Anhui 246000,China)
出处
《肝胆胰外科杂志》
CAS
2023年第8期483-488,共6页
Journal of Hepatopancreatobiliary Surgery
关键词
门静脉积气
肠气囊肿症
急腹症
心率
portal venous gas
pneumatosis cystoides intestinalis
acute abdomen
heart rate
