| Objective: Strangulated intestinal obstruction is one of the more dangerous abdominal emergencies in the emergency department.It can cause ischemia and edema after onset.,If not early diagnosis treatment intervention,can cause bowel ischemia,the oxygen supply can not meet the intestinal mucosa epithelial cells maintain normal physiological function of consumption,killed bowel tissue edema,mucosal cells,and cause a series of physiological changes,such as septic shock,systemic inflammatory response syndrome,acute lung injury and even death and other serious complications.Early and accurate detection of strangulated intestinal obstruction is still one of the problems of scholars at home and abroad.At present,the early diagnosis of strangulated intestinal obstruction is still one of the troubles of scholars both at home and abroad.Due to the lack of biological diagnostic indicators that can prompt specific and sensitive intestinal ischemia at the early stage.Therefore,it is still not practical to rely on the traditional indicators such as physician experience,blood routine,biochemical,abdominal X-ray/CT and abdominal signs to detect the strangulation of strangulated intestinal obstruction early.Therefore,the focus turned to have a convenient,fast and has good sensitivity and specificity can prompt early intestinal ischemia and necrosis serological indicators.By investigating a total of 122 patients with intestinal obstruction,including a total of 64 simple intestinal obstruction patients group(simple),strangulation obstruction patient 58 people(strangulation group),simple groups are actively by fasting water after admission,the venous nutrition support,runchang purge discharged from hospital after cure,strangulation group were in the emergency department after admission,actively improve the relevant examination,has carried on the emergency operation.All the above patients were patients with intestinal obstruction admitted by the first affiliated hospital of Dalian medical university from December 2003 to October 2017,and the diagnosis was determined by specific diagnosis.Grouping based on the above comparison NLR(the ratio of neutrophils,lymphocytes,PLR(platelet-lymphocyte ratio),((the ratio of lymphocytes,mononuclear cells in the intestinal obstruction accurately find the value of intestinal strangulation,as early as possible as early in the disease in time find strangulation obstruction provides effective reference coefficient.Methods: To review a large number of articles on early diagnosis of strangulated intestinal obstruction biomarkers and to determine the main contrast serological markers for this study as NLR,PLR,LMR.Survey of Dalian medical university first affiliated hospital admissions for further diagnosis and treatment of patients with intestinal obstruction,commencement date for December 2003 to October 2017,all the patients on the basis of diagnosis and into,exclusion criteria are divided into simple intestinal obstruction patients(control group),strangulation obstruction patients (experimental group),strangulated intestinal obstruction Diagnostic criteria to see and pathological surgery prevail.All patients were enrolled in the first count without hematuria such as neutrophils(N),platelets(PLT),lymphocytes(L),monocytes(M),white blood cells(WBC)Divide the number of neutrophils by the number of lymphocytes to obtain the ratio of NLR,the number of platelets divided by the number of lymphocytes to obtain the ratio of PLR,the number of lymphocytes divided by the number of mononuclear cells to obtain the ratio of LMR.The gender,age,leucocyte,neutrophil,lymphocyte,monocyte,NLR,PLR and LMR of two groups of patients were statistically analyzed.Categorical variables were expressed as frequency and percentage,continuous variables were expressed as mean and standard deviation,categorical variables were compared using chi-square test or Fisher's exact test,and ttest or Mann-Whitney U test was used to compare continuous variables between groups,Variable value p < 0.05.Results: According to the intestinal obstruction disease diagnostic criteria and grouping,and exclusion criteria,the survey selected a total of 122 cases of patients,including simple intestinal obstruction in 64 cases(male 37(57.81%),female,27(42.19%),average age 60.52±17.83],strangulation obstruction 58 cases(male 32(55.17%),female,26(44.83%),61.71±20.62 years).In the two groups in gender,age,number of number of lymphocytes,monocytes,PLR and temperature value comparison,P values were 0.456,0.733,0.547,0.05,0.343,0.745,these variables are regarded as no statistical significance.The P value was 0.000(P<0.05),and the P value of platelet was 0.015.The three indexes were analyzed by ROC curve.According to the ROC curve,according to the results of the area under the ROC curve AUC of N = 0.789(95% CI: 0.709 0.870),P = 0.000,when the value of N is 8.12,about an index is the largest,the sensitivity was 72.4%,specificity of 75%,the overall accuracy of 72.41%.Under the ROC curve of WBC,AUC=0.754(95% CI: 0.688-0.840),P=0.000,and when WBC value was 10.63,the index was the largest.The sensitivity was 69%,specificity was 73.4%,and the overall accuracy was70.18%.Under the ROC curve of PLT,AUC=0.579,indicating that its test utility is low.Under the ROC curve of NLR,AUC=0.785(95% CI: 0.702-0.868),P=0.000.When the NLR value is 10.03,the Jordan index is the largest.The sensitivity was 70.1%,specificity was 84.4%,and the overall accuracy was 80.39%.The area under the ROC curve of LMR is 0.326,indicating that its testing utility is low.Conclusion: NLR has certain clinical value for early diagnosis of strangulated intestinal obstruction. |
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