本文選題：急性膽囊炎 + 壞疽　； 參考：《山西醫(yī)科大學(xué)》2013年碩士論文

【摘要】：研究目的： 急性壞疽性膽囊炎作為臨床外科較為棘手的急癥，以發(fā)病急、病情重、發(fā)展快、病死率高而受到全世界各國(guó)外科臨床醫(yī)生的廣泛關(guān)注。該病的治療需要早期手術(shù)干預(yù)，才能避免病情進(jìn)一步惡化。這就需要我們從患者術(shù)前的資料（包括基本資料、生命體征、既往史、化驗(yàn)及檢查）中，分析得出壞疽性膽囊炎術(shù)前、預(yù)后危險(xiǎn)因素。 研究方法： 1. 選取山西醫(yī)科大學(xué)第二醫(yī)院普外科2008年12月~2012年10月收治的114例膽囊炎患者的病歷資料。 2.按照術(shù)中探查、術(shù)后病理結(jié)果分2組，急性壞疽性膽囊炎組和普通膽囊炎對(duì)照組，分別為36例和78例患者。 3.通過統(tǒng)計(jì)學(xué)分析計(jì)算比較兩組間性別、年齡、入院體溫、體重指數(shù)、總膽紅素、丙氨酸氨基轉(zhuǎn)移酶、天門冬氨酸氨基轉(zhuǎn)移酶、血脂、糖代謝、白細(xì)胞計(jì)數(shù)、膽囊超聲影像、心血管疾病病史、是否有結(jié)石及既往膽囊炎發(fā)作史。 4.最后，利用多變量logistic回歸分析多個(gè)指標(biāo)共同對(duì)急性壞疽性膽囊炎術(shù)前預(yù)后的影響。 研究結(jié)果： 1.在定量資料分析中，入院體溫、總膽紅素、甘油三酯、白細(xì)胞計(jì)數(shù)因素的兩組間差異有統(tǒng)計(jì)學(xué)意義(P0.05)，這些指標(biāo)的升高是壞疽性膽囊炎術(shù)前、預(yù)后的危險(xiǎn)因素。 2.在定性資料分析中，性別、入院體溫、總膽紅素、總膽固醇、白細(xì)胞計(jì)數(shù)、糖代謝、膽囊超聲影像因素的兩組間差異有統(tǒng)計(jì)學(xué)意義(P0.05)，這些指標(biāo)的異常是壞疽性膽囊炎術(shù)前、預(yù)后的危險(xiǎn)因素。 3.在多因素分析中，膽囊超聲影像、入院體溫、總膽紅素與急性壞疽性膽囊炎存在關(guān)系密切CP0.05)，且各自的優(yōu)勢(shì)比分別為0.141、0.167、0.238。 研究結(jié)論： 1.通過本實(shí)驗(yàn)的臨床對(duì)照研究，確定壞疽性膽囊炎術(shù)前預(yù)后危險(xiǎn)因素有：男性、入院體溫升高、總膽紅素升高、白細(xì)胞計(jì)數(shù)升高、糖代謝異常、膽囊超聲影像異常。其中膽囊超聲影像、入院體溫、總膽紅素與急性壞疽性膽囊炎存在關(guān)系密切； 2.這些術(shù)前預(yù)后危險(xiǎn)因素，，可以指導(dǎo)臨床上對(duì)急性壞疽性膽囊炎的早期診斷，可作為緊急手術(shù)干預(yù)的指征。做到對(duì)急性壞疽性膽囊炎的“早發(fā)現(xiàn)”、“早診斷”、“早治療”，為廣大醫(yī)務(wù)工作者，更是為了百姓的健康服務(wù)。
[Abstract]:Objective: acute gangrenous cholecystitis, as a difficult emergency in clinical surgery, has been widely concerned by surgeons all over the world because of its acute onset, severe disease, rapid development and high fatality rate. The treatment of the disease requires early surgical intervention to avoid further deterioration. This requires us to analyze the preoperative prognostic risk factors of gangrenous cholecystitis from the data (including basic data, vital signs, past history, laboratory tests and examinations) of patients with gangrenous cholecystitis. Methods: 1. The medical records of 114 patients with cholecystitis admitted from December 2008 to October 2012 in the General surgery Department of the second Hospital of Shanxi Medical University were selected. 2. According to the intraoperative exploration and pathological results, the patients were divided into two groups: acute gangrenous cholecystitis group and general cholecystitis control group, 36 cases and 78 cases, respectively. Sex, age, body temperature, body mass index, total bilirubin, alanine aminotransferase, aspartate aminotransferase, blood lipid, glucose metabolism, white blood cell count, cholecyst ultrasound imaging were calculated and compared between the two groups. Cardiovascular disease history, whether have stone and previous history of cholecystitis attack. 4. Finally, multivariate logistic regression analysis was used to evaluate the preoperative prognosis of acute gangrenous cholecystitis. Results: 1. In the quantitative data analysis, there were significant differences in the factors of admission temperature, total bilirubin, triglyceride and white blood cell count between the two groups. The increase of these indexes was a risk factor for the prognosis of gangrenous cholecystitis before operation. 2. In qualitative data analysis, there were significant differences in sex, body temperature, total bilirubin, total cholesterol, white blood cell count, glucose metabolism and cholecyst ultrasound between the two groups (P 0.05). The abnormality of these indexes was preoperative gangrenous cholecystitis. Prognostic risk factors. In multivariate analysis, cholecyst ultrasound, body temperature and total bilirubin were closely related to acute gangrenous cholecystitis, and their respective odds ratio was 0.141 ~ 0.167 ~ 0.238. Conclusion: 1. According to the clinical controlled study, the prognostic risk factors of gangrenous cholecystitis before operation were determined as follows: male, admission body temperature, total bilirubin, white blood cell count, abnormal glucose metabolism and abnormal ultrasound image of gallbladder. Among them, ultrasound image of gallbladder, body temperature and total bilirubin were closely related to acute gangrenous cholecystitis. These prognostic risk factors can guide the early diagnosis of acute gangrenous cholecystitis and can be used as an indication of emergency surgical intervention. To achieve "early detection", "early diagnosis" and "early treatment" of acute gangrenous cholecystitis, for the majority of medical workers, but also for the health of the people.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類號(hào)】：R657.41

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本文編號(hào)：2009752