简介麻痹性肠梗阻(PI)常见于危重住院患者。患有胰胆管疾病的患者将需要内镜逆行胰胆管造影术(ERCP)进行治疗。这里,我们将探讨行ERCP的麻痹性肠梗阻患者与术后并发症之间的关系,这是以前没有做过的。方法选择2007年至2017年在全国住院患者样本数据库中接受ERCP的患者。病例按年龄1:1匹配,性别,种族,以及有和没有手术前麻痹性肠梗阻的患者的Elixhauser合并症指数。主要结果是麻痹性肠梗阻和住院时间之间的关联,付款人状态,和平均总费用。次要结果是麻痹性肠梗阻和ERCP后并发症之间的关联(感染,胰腺炎,胆管炎,胆囊炎,穿孔,出血),和总死亡率。卡方分析用于比较分类数据,连续数据采用独立t检验。回归分析用于评估主要和次要结果。结果2007年至2017年2,008,217例住院患者中,43,643例患者出现麻痹性肠梗阻,43,859例患者没有,在接受ERCP之前。年龄没有差异,性别,种族,或Elixhauser合并症指数。停留时间的差异,付款人状态,和总收费显著(p<0.001)。麻痹性肠梗阻患者ERCP后感染的风险增加,胰腺炎,胆管炎,胆囊炎,穿孔,出血,和总死亡率(p<0.001)。结论行ERCP治疗的麻痹性肠梗阻患者住院时间较长,更高的总费用,而且可赔性较低。他们还增加了ERCP后感染的风险,胰腺炎,胆管炎,胆囊炎,穿孔,出血,和总死亡率,可能来自危重疾病和全身炎症反应。
Introduction Paralytic ileus (PI) is often seen in critically ill hospitalized patients. Those with pancreaticobiliary diseases will require endoscopic retrograde cholangiopancreatography (ERCP) for management. Here, we will explore the association between patients with paralytic ileus who underwent ERCP and post-procedural complications, which has not been done before. Methods Patients who underwent ERCP between 2007 and 2017 in the National Inpatient Sample database were selected. Cases were matched 1:1 by age, gender, race, and the Elixhauser comorbidity index for patients with and without pre-procedural paralytic ileus. Primary outcomes were associations between paralytic ileus and length of stay, payor status, and average total charges. Secondary outcomes were associations between paralytic ileus and post-ERCP complications (infection, pancreatitis, cholangitis, cholecystitis, perforation, hemorrhage), and overall mortality. The Chi-squared analysis was used to compare categorical data, and the independent t-test was used for continuous data. Regression analysis was used to assess primary and secondary outcomes. Results Of 2,008,217 hospitalized patients from 2007 to 2017, 43,643 patients had paralytic ileus and 43,859 patients did not, before undergoing ERCP. There were no differences in age, gender, race, or the Elixhauser comorbidity index. The differences in the length of stay, payor status, and total charges were significant (p<0.001). Patients with paralytic ileus had increased risks of post-ERCP infection, pancreatitis, cholangitis, cholecystitis, perforation, hemorrhage, and overall mortality (p<0.001). Conclusions Patients hospitalized with paralytic ileus who underwent ERCP had a longer length of stay, higher total charges, and were less compensable. They also had increased risks for post-ERCP infection, pancreatitis, cholangitis, cholecystitis, perforation, hemorrhage, and overall mortality, which can be from critical illness and the systemic inflammatory response.