摘要
目的探讨内脏脂肪面积(VFA)对克罗恩病(CD)术后发生手术部位感染(SSI)的影响,为完善CD患者围手术期优化策略提供参考.方法回顾性分析2017年12月至2018年12月在东部战区总医院炎症性肠病治疗中心接受部分肠切除术治疗的86例CD患者的病例资料,将入选患者分为SSI组和非SSI组,选择一般资料和围手术期相关因素作为变量,采用单因素和多因素(Logistic回归模型)分析术后发生SSI的危险因素,并用ROC曲线确定预测价值.结果术后SSI发生率为12.8%(切口感染9例,腹腔脓肿2例),单因素分析显示吸烟史(P=0.145)、急诊手术(P=0.168)、污染切口(P=0.026)和术前C-反应蛋白>10 mg/L(P=0.169)是CD患者术后发生SSI的可能危险因素(以P<0.2为标准).SSI组和非SSI组VFA差异有统计学意义[(78.6±62.4)cm2比(42.2±25.2)cm2,P<0.001)],而体质指数、皮下脂肪面积及内脏脂肪/皮下脂肪的比率差异均无统计学意义(P>0.05).多因素分析显示VFA是CD术后发生SSI的独立危险因素(OR=1.029,95%CI:1.006~1.054,P=0.015).ROC曲线分析显示VFA有中等程度预测术后SSI价值(曲线下面积:0.732,95%CI:0.588~0.876).结论VFA是CD术后发生SSI的独立危险因素,因此,VFA高的CD患者应调整围手术期营养支持方案及加强运动锻炼,同时采取更加积极的措施预防术后SSI的发生.
Objective To evaluate the effect of visceral fat area(VFA)on surgical site infection(SSI)after abdominal surgery in Crohn's disease(CD)surgery as reference for perioperative optimization.Methods The clinical data of 86 CD patients who underwent intestinal resections from December 2017 to December 2018 at the General Hospital of Eastern Theater Command were retrospectively analyzed.Patients were divided into SSI group and non-SSI group.Relevant patient data and perioperative variables were selected,and both univariate and multivariate(Logistic regression model)analyses were performed to identify the risk factors for SSI after surgery.Receiver operating characteristic(ROC)curve analysis was used to evaluate the predictive value.Results The incidence of SSI after surgery was 12.8%(incisional infection in 9 cases,abdominal abscess in 2 cases).By univariate analysis,smoking(P=0.145),emergency operation(P=0.168),dirty incision(P=0.026)and preoperative CRP>10 mg/L(P=0.169)were potential risk factors(P<0.2)of SSI after abdominal surgery in CD.There was statistically significant difference in VFA[(78.6±62.4)cm2 vs.(42.2±25.2)cm2,P<0.001]instead of BMI,subcutaneous fat area and visceral to subcutaneous fat ratio between SSI group and non-SSI group(all P>0.05).Multivariate analysis showed VFA was an independent risk factor of SSI after abdominal surgery in CD(OR=1.029,95%CI:1.006-1.054,P=0.015).ROC curve analysis showed VFA was moderately accurate(AUC:0.732,95%CI:0.588-0.876).Conclusions VFA is an independent risk factor of SSI after abdominal surgery in CD.Therefore,CD patients with high VFA should adjust perioperative nutritional support formula,strengthen exercise and take more active measures to prevent SSI after abdominal surgery.
作者
蔡星辰
李毅
郭振
柏文霞
王建宁
朱维铭
Cai Xingchen;Li Yi;Guo Zhen;Bai Wenxia;Wang Jianning;Zhu Weiming(Department of Digestive Medicine,The Affiliated Jiangning Hospital,Nanjing Medical University,Nanjing 211100,China;Department of General Surgery,General Hospital of Eastern Theater Command,PLA,Nanjing 210002,China)
出处
《中华炎性肠病杂志（中英文）》
2019年第4期331-335,共5页
Chinese Journal of Inflammatory Bowel Diseases
关键词
克罗恩病
内脏脂肪
手术部位感染
Crohn's disease
Visceral fat
Surgical site infection
