| 摘要: |
| 目的 探讨腹腔引流液在胃癌患者术后并发腹腔感染的早期预警及评估预后的临床价值。方法:选择2017年1月—2020年12月在天津市肿瘤医院接受胃癌手术的胃癌患者130例。根据其腹腔感染情况分为两组:感染组(77例)与对照组(53例)。记录并比较两组患者的临床资料，采用二元Logistic回归分析寻找预测腹腔感染的高危因素，绘制受试者工作特征(ROC)曲线评估术后腹腔引流液中实验室检查常规、生化指标对腹腔感染的预测价值，计算ROC曲线下面积(AUC)并进行比较。采用COX回归分析及K-M分析比较不同指标对于腹腔感染患者转归及预后的预测价值。结果:两组的年龄、急性生理与慢性健康评分II(APACHE Ⅱ评分)、序贯器官衰竭评分(SOFA评分)、腹腔引流液白细胞、腹腔引流液多形核细胞比例，腹腔引流液葡萄糖、血糖/腹腔引流液葡萄糖比值、血降钙素原(PCT)、重症监护科(ICU)停留时间比较均有统计学差异；APACHE Ⅱ评分，T2分期、T4a分期、N1~N3、血糖是术后发生腹腔感染的独立危险因素；血糖/腹腔引流液葡萄糖比值的AUC面积最大，且截断值为1.6439，当血糖/腹腔引流液葡萄糖比值>1.6439时，腹腔感染可能性明显增大。腹腔引流液多形核细胞百分比升高及ICU期间使用抗生素是影响患者ICU转归及入住ICU时间的危险因素，腹腔感染患者的ICU入住时间长于对照组患者，且血糖/腹腔引流液葡萄糖比值<1.6439患者的入住ICU时间略短于比值≥1.6439的患者。结论:腹腔引流液“血糖/腹腔引流液葡萄糖比值”可作为早期预测腹腔感染的关键指标，且比值≥1.6439的患者腹腔感染的几率大大增加。 |
| 关键词: 胃癌 腹腔感染 腹腔引流液 实验室检查 预后 |
| DOI：10.3969/j.issn.1007-6948.2025.01.006 |
| 投稿时间：2024-09-20 |
| 基金项目:天津市医学重点学科(专科)建设项目(TJYXZDXK-009A)；天津市卫生健康科技项目(TJWJ2022MS006) |
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| Clinical value of abdominal drainage fluid in the diagnosis and prediction of early abdominal infection after gastric cancer surgery |
| LYU Yang,HAN Tao,WANG Dong-hao |
| Department of Intensive Care Unit, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin＇s Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin300060, China |
| Abstract: |
| Objective To explore clinical value of abdominal drainage fluid in early warning and prognosis evaluation of postoperative abdominal infection in gastric cancer patients. Methods A total of 130 gastric cancer patients who were admitted to ourhospital and underwent gastric cancer surgery between January 2017 and December 2020 were selected as study subjects. Record all clinical data of enrolled patients (patients with abdominal infections (77 cases) and non-abdominal infections (53 cases). Binary Logistics regression analysis was used to identify high-risk factors for predicting abdominal infection. Receiver operating characteristic (ROC) curves to evaluate predictive value of laboratory routine and biochemical indicators in postoperative abdominal drainage fluid for abdominal infection. Area under ROC curve (AUC) was calculated and compared. Cox regression analysis and K-M analysis were used to compare predictive value of different indicators for outcome and prognosis of patients with abdominal infections. Results There were statistically significant differences in APACHE Ⅱ score, SOFA score, peritoneal fluid leukocyte count, peritoneal fluid glucose, blood leukocyte count, blood glucose/peritoneal fluid glucose ratio, blood PCT, and ICU stay time between two groups; APACHE Ⅱ score, T2 stage, T4a stage, N1-N3, and blood glucose were independent risk factors for postoperative abdominal infection; AUC area of blood glucose/abdominal fluid glucose ratio was largest, and cut-off value was 1.6439. When blood glucose/abdominal fluid glucose ratio is greater than 1.6439, possibility of abdominal infection is significantly increased. Percentage of polymorphonuclear cells in abdominal drainage increasing and utilized of antibiotics during ICU were risk factors that affect ICU outcome and ICU stay time. Patients with abdominal infections have longer ICU stays than control group, and patients with blood glucose/abdominal drainage glucose ratio<1.6439 have slightly shorter ICU stay time than that with ratio≥1.6439. Conclusion "blood glucose/abdominal drainage glucose ratio" can be used as a key indicator for early prediction of abdominal infection, and patients with a ratio≥1.6439 have a significantly increased risk of abdominal infection. |
| Key words: Gastric cancer abdominal infection abdominal drainage laboratory examination prognosis |
