Analysis Of The Prognostic Effects Of Multiple Clinical Factors Of Patients With Descending Necrotizing Mediastinitis

ObjectiveTo investigate the high risk factors of prognosis and death in patients with descending necrotizing mediastinum.MethodsRetrospective analysis was performed on 120 patients with descending necrotizing mediastinitis who were admitted to the people's hospital of henan university from January 2008 to March 2020.There were a total of 60 patients with type I descending mediastinitis,30 of whom underwent incision and drainage of mediastinal abscess via cervicotomy,and the remaining 30 patients underwent drainage of mediastinal abscess via cervicotomy combined with video-assisted thoracoscopic mediastinal abscess removal.There were a total of 60 patients with type II descending necrotizing mediastinitis,and all patients with type II descending necrotizing mediastinitis underwent mediastinal drainage combined with thoracoscopic mediastinal drainage via cervicotomy,including 30 patients with type IIA descending necrotizing mediastinitis and 30 patients with type IIB descending necrotizing mediastinitis.Record was incorporated into all of the patients in the study of age,gender,weight mass index(BMI),whether received tracheotomy during hospitalization,patient feeling discomfort symptoms until the occurrence of hospital treatment time,whether patients with diabetes,surgical treatment times during the hospitalization,whether it is complicated with sepsis,descending necrotizing mediastinitis type and so on clinical diagnosis and treatment,And then,the patients were aged?50 years,body mass index(BMI)?24kg/m~2,during the hospitalization,tracheotomy was performed,the time from the onset of discomfort to the treatment was no more than 3 days,the patients were complicated with diabetes,the number of surgeries performed during the hospitalization was no less than 2 times,sepsis,the type and gender of descending necrotizing mediastinitis.Chi-square(?~2)test showed that(P<0.05)was statistically significant.Preliminary discriminant out all the factors into the risk of death for patients in this study the sensitive factors,and then extract the sensitive factors by using logistic regression analysis of the odds ratio(OR)and 95%confidence interval,to analyze the sensitive factors of into the risk of death in patients with descending necrotizing mediastinitis,Finally the risk factors for death prognosis of descending necrotizing mediastinitis were determined.ResultsAll the 120 patients included in this group received surgical treatment,and the total number of dead patients was 14,with a mortality rate of 11.7%.Among the included factors,the age of the patients was?50years old,the body mass index(BMI)was?24kg/m~2,the patients had diabetes,the number of surgeries performed in the patients was?2 times during hospitalization,the patient developed sepsis,the patients with descending necrotizing mediastinitis of different types,the patients underwent tracheotomy during hospitalization,and the time between the onset of discomfort symptoms and the visit to the hospital was?3days.Chi-square(?~2)test was performed for all the study factors,and the results showed that only the patients with diabetes,the number of times the patients underwent surgery?2 times during hospitalization,P<0.05 was preliminarily identified and selected as the sensitive risk factors that may lead to the death of the patients in this study.Among them,there were 33 patients with diabetes,11 of whom died,87 of whom did not have diabetes,and 3 of whom died.There were 22 patients with the number of operations?2 times during hospitalization,and 6 patients died.There were 98 patients with the number of operations less than 2times during hospitalization,among which 8 died.There were 60 patients with descending necrotizing mediastinitis of type I,with 6 deaths,and 60 patients with descending necrotizing mediastinitis of type II,with 8 deaths.According to the logistic regression analysis of sensitive risk factors,the number of operations OR=1.833,95%confidence interval(1.012-3.019),combined with diabetes OR=1.982,95%confidence interval(1.052-3.733),were the high-risk risk factors for death in patients with descending necrotizing mediastinitis(P<0.05).ConclusionThe high risk factors for perioperative death were multiple surgical treatments and diabetes during hospitalization.In the treatment of patients with descending necrotizing mediastinitis,the correct selection of effective surgical drainage for patients with different types of descending necrotizing mediastinitis is very important to reduce the rate of reoperation and improve the prognosis of patients with descending necrotizing mediastinitis.For people with descending necrotizing mediastinitis combine with diabetes,more precise blood glucose regulation and reduction of the occurrence of fatal complications are important factors to reduce the mortality and improve the prognosis of patients.