肥胖症患者腹腔镜胃旁路术后并发症的指标

O. Ioffe, V. O. Nevmerzhytskyi, M. Kryvopustov, Yurii A. Dibrova, Y. Tsiura
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引用次数: 0

摘要

简介减肥手术是治疗病态肥胖症最有效的方法之一,其效果持久。随着肥胖症治疗手术方法的增多,与术后并发症相关的问题也越来越多。近年来,人们一直在积极研究术后使用特殊检查单的问题。这将有助于优化术后患者病情的监测过程。本研究的目的是:建立一个检查单模型,以防止发现肥胖患者腹腔镜胃旁路术后并发症。材料和方法。根据制定的核对表,在国立波戈莫列茨医科大学普通外科二系的基础上,对2019-2023年间接受腹腔镜胃旁路术的肥胖患者的情况进行了研究。检查表包括以下标准:VAS量表上的疼痛程度、恶心程度、进食情况、活动能力、是否希望出院回家、腹肌紧张度、小腿肌肉疼痛、心率、血氧饱和度、24小时内出院引流次数、体温、收缩压、中心静脉压、实验室诊断、腹腔镜旁路术后疼痛程度、腹腔镜旁路术后疼痛程度、腹腔镜旁路术后疼痛程度、腹腔镜旁路术后疼痛程度、腹腔镜旁路术后疼痛程度、腹腔镜旁路术后疼痛程度、中心静脉压、实验室诊断、血红蛋白浓度下降、术后白细胞水平、术后 C 反应蛋白水平、血降钙素水平、红细胞沉降率水平、白细胞公式是否左移。评估是否存在并发症,采用单变量逻辑回归和 ROC 分析方法对检查表的参数进行分析,以早期发现并发症并确定未来出现并发症的几率。结果每 218 人中有 18 人(8.2%)出现并发症。最常见的并发症是出血,发生率为 6/18(33.3%)。12/18 例中有 12 例(66.6%)进行了再次手术,1 例进行了内窥镜治疗,5 例采用了保守方法。根据检查表,31.81%具有阳性预测值(PPV),99.56%具有阴性预测值(NPV)。检查表总分的最佳分界点为 6 分。检查表预后阳性的患者出现 VSH 并发症的几率更高 - 4.5 (95% CI 1.8-9.72),P <0.001。结论并发症发生率为18/218(8.2%)。根据检查表,心率、收缩压和活动能力是预测术后并发症的很好指标。由于预后阴性结果较高,核对表是确定患者是否准备好出院的最佳选择。由于预后阳性结果较低,所评估的核对表需要根据已获得的结果进行进一步的修改和优化。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
MARKERS OF COMPLICATIONS AFTER LAPAROSCOPIC GASTRIC BYPASS IN PATIENTS WITH OBESITY
Introduction. Bariatric surgery is one of the most effective methods of treating morbid obesity, which allows for a long-lasting result. Along with the increase in the number of operative methods of obesity treatment, the relevance of issues related to postoperative complications is increasing. In recent years, the issue of using special checklists after surgery has been actively investigated. This will help optimize the process of monitoring patients' condition in the postoperative period. The aim of the study: to develop a check-list model to prevent the detection of complications after laparoscopic gastric bypass in obese patients. Materials and methods. On the basis of the developed checklist, a study of the condition of obese patients, who underwent laparoscopic gastric bypass during 2019-2023, was conducted on the basis of the Department of General Surgery No. 2 of the Bogomolets National Medical University. The checklist included the following criteria: the level of pain on the VAS scale, the level of nausea, eating, mobility, whether there is a desire to be discharged home, abdominal muscle tension, pain in the calf muscles, heart rate, oxygen saturation in the blood, the number drainage discharge within 24 hours, temperature, systolic blood pressure, central venous pressure, laboratory diagnosis, decrease in hemoglobin concentration, leukocyte level after surgery, C-reactive protein level after surgery, blood procalcitonin level, erythrocyte sedimentation rate level, the presence of a shift in the leukocyte formula to the left. The presence of complications was assessed, the parameters of the checklist were analyzed using univariate logistic regression and ROC analysis for early detection of complications and determination of the chance of complications in the future. Results. Complications occurred in 18/218 (8.2%). The most frequent complication was bleeding in 6/18 (33.3%). Reoperation was performed in 12 cases of 12/18 (66.6%), endoscopic treatment was performed in 1 case, and conservative methods were used in 5 cases. According to the checklist, 31.81% had a positive predictive value (PPV) and 99.56% had a negative predictive value (NPV). The optimal cut-off point of the total score of the checklist was 6. Patients with a positive prognosis of the checklist have a higher chance of developing complications of VSH – 4.5 (95% CI 1.8-9.72), p <0.001. Conclusions. The complication rate was 18/218 (8.2%). According to the checklist, heart rate, systolic blood pressure and mobility are very good predictors of postoperative complications. The checklist is the best option for determining the readiness of patients to be discharged from the hospital due to a high prognostic negative result. Due to the low prognostic positive result, the evaluated checklist needs additional modification and optimization taking into account the results already obtained.
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