| Objective:To investigate the clinical characteristics and the risk factors of Poor Prognosis in patients for acute intestinal necrosis.Methods:The retrospectively study enrolled 291 adult patients diagnosed with intestinal necrosis and surgical treatment from June 2008 to October 2017 in department od digestive surgery,xijing digestive hospital.The patient's demographic characteristics,baseline disease,Preoperative clinical symptoms,laboratory and imaging examinations,surgical methods,postoperative complications,and outcomes were recorded to compare differences for prognosis.Analysis the risk factors of the death,complication,SIRS.First,the patient's demographic characteristics,clinical symptoms and signs,laboratory and imaging examination data,and intraoperative findings were screened for univariate analysis.Further statistically significant multivariate stepwise logistic regression analysis was performed to determine the prognosis of acute small intestinal necrosis and which major risk factors were involved.The death,complication or SIRS was grouped to investigate the risk factors of acute intestinal necrosis.Receiver operating characteristic(ROC)would be constructed according to final patient death will be occurred.Meanwhile calcuateed the area under the curve(Area under the curve,AUC),and the cut off value,and the sensitivity and specificity of the predictive model.P<0.05 in the whole study indicated statistically significant differences.Results:This study included a total of 291 clinical record of acute intestinal necrosis.There was 185(63.6%)male and 106(36.4%)female.All 291 patients had different degrees of small intestinal necrosis.The length of intestinal necrosis was from10cm to the whole small intestine.Anastomosis was made in 138 patients(47.4%)and the enterostomy was made in 153 patients(52.6%).Of the 29 patients(11.0%)died within 40 days,and died from multiple organ failure(MODS)in 3(10.3%)and septic shock in 17(58.6%).Multivariate analysis showed that the age was greater than 53years,the shock index was greater than 0.8,coronary heart disease was combined,electrolyte imbalance,the operation lasted more than 155 minutes,small intestinal perforation was found to be an independent risk factors for death of acute intestinal necrosis.Based on the independent factors,we constructed the prediction model of death.The area under the curve and the optimal cut-off point were 0.836 and 3 points,and the sensitivity and specificity were 0.759 and 0.721.109 cases(37.5%)had various complications after operation,include:shock(43.8%),abdominal infection(15.8%),pulmonary infection(15.5%),renal insufficiency in 30 cases(10.3%),respiratory failure 7 cases(2.4%).Patients with albumin?34.9 g/L,preoperative pulmonary infection,electrolyte imbalance,atrial fibrillation,intraoperative small intestine perforation,necrotic small intestine mean length>100cm is an independent risk factor for postoperative complications of acute small intestinal necrosis.Based on the that independent factors,the predictive model of the complication was constructed.The area under the curve and the optimal cut-off value were 0.825 and 2 points,and the sensitivity and specificity were 0.853 and 0.654.This model can better predict the risk of complications.factor.SIRS response occurred in 161 patients(58.4%).Preoperative SIRS,white blood cells>14.1×10~9/L,imaging examination or intraoperative mesenteric thrombosis,surgical duration>155 minutes,an independent risk factor for SIRS after acute small intestinal necrosis.Conclusion:The incidence of acute intestinal necrosis male-female ratio was1.75:1.The onset time ranged from 1 hour to 6 days,with an average onset time of 11.2hours and a relatively short time span.The mortality rate was 10.0%.Based on the data of this investigated,88.3%of patients of small intestinal necrosis receive CT examination,and have a positive findings.Therefore CT can be used as the main imaging diagnostic method for acute intestinal necrosis.Patients with acute intestinal necrosis were found to be older than 53 years,with a shock index greater than 0.8,with coronary heart disease,electrolyte imbalance,the operation lasted more than 155minutes,small intestinal perforation,while laparoscopic exploration or laparoscopic exploration revealed small intestinal perforation is independent risk factor for death for acute intestinal necrosis.Acute intestinal necrosis is associated with a higher risk of death when there are three or more risk factors.This model can better predict the risk factors of death.The incidence of postoperative complications of acute small intestinal necrosis was 37.5%,and the mortality rate of complications was 23.9%.The incidence of postoperative SIRS was 58.4%,and the mortality rate of SIRS was 14.9%.patients with albumin?34.9g/L,preoperative pulmonary infection,electrolyte imbalance Atrial fibrillation,intraoperative perforation of small intestine,and average length of necrotic small intestine>100 cm are independent risk factors for postoperative complications of acute small intestinal necrosis.Acute intestinal necrosis is associated with a higher risk of complications when there are two or more risk factors.This model can better predict the risk factors of complications.Preoperative SIRS,white blood cells>14.1×10~9/L,imaging examination or intraoperative mesenteric thrombosis,surgical duration>155minutes,an independent risk factor for SIRS after acute small intestinal necrosis. |
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