复杂性阑尾炎的影响因素及与术前延误的关系*

Relationship between pre-operation delay and complicated appendicitis*

摘要:

目的 探讨复杂性阑尾炎易发因素及其与术前延误的关系，以期为提高急性阑尾炎的治疗效果提供理论依据。方法 选取2016年11月—2017年12月绵阳市第三人民医院确诊为急性阑尾炎的患者562例。按最终诊断分为复杂性阑尾炎和非复杂性阑尾炎两组，比较组间人口学、症状体征、辅助检查及术前延误时间等临床特点的差异。结果 Logistic回归多因素分析显示年龄≥60岁、合并慢性病、粪石嵌顿、阑尾长度> 10?cm、总体延误（≤24?h，>24～48?h，>48～72?h，>72?h）是复杂性阑尾炎的独立危险因素。结论 术前总体延误会影响急性阑尾炎的病情和预后，对急性阑尾炎患者，应及早进行手术。

Abstract:

Objective To investigate the relationship between pre-operation delay and complicated appendicitis and to provide a theoretical basis for improving the therapeutic effect of acute appendicitis. Methods Patients admitted into our hospital from November 2016 to December 2017 were divided into complicated appendicitis and uncomplicated appendicitis based on the final diagnosis, the difference of demographic, clinical characteristics and pre-operation delay between patients with different type appendicitis was analyzed. Results Univariate analysis revealed that the difference in age, working day onset of symptom, pre-operation CT scanning, comorbidity, fever > 38℃, right lower abdominal rebound tenderness, white blood cell count, neutrophil percentage, high sensitivity C-reactive protein, fecal stone incarcerated, length of appendix and total delay was significant between patients in two groups. Multivariate analysis by Logistic regression revealed that age≥60 years [OlR?=?1.94, (95% CI: 1.16, 3.25), P?=?0.012), comorbidity [OlR?=?2.16, (95% CI: 1.31, 3.54), P?=?0.002], fecal stone incarcerated [OlR?=?2.80, (95% CI: 1.79, 4.39), P? 10?cm [OlR?=?3.94, (95% CI: 1.96, 7.93), P? 24 to 48?h: [OlR?=?2.27, (95% CI: 1.31, 3.95), P?=?0.004; >48 to 72?h: [OlR=?2.62, (95% CI: 1.24, 5.55), P?=?0.012]; >72?h: [OlR?=?4.25, (95% CI: 1.78, 10.15), P?=?0.001] were independent risk factors of complicated appendicitis. Conclusions The total preoperative delay has significant impact on the clinical course and prognosis of patients with acute appendicitis, the appendectomy should be conducted as early as possible in these patients.