Multivariate Analysis Of Surgical Decision Making For Mechanical Intestinal Obstruction Management With Nasal Ileus Tube

Objective:To investigate the independent factors influencing the surgical decision to treat mechanical intestinal obstruction by nasal ileus catheter,and to develop a logistic regression model to evaluate its accuracy,sensitivity and specificity in predicting the need for surgical treatment even after nasal ileus catheterization in patients with mechanical intestinal obstruction,so as to provide a basis for clinical surgical treatment.Methods:The data of 115 patients with mechanical intestinal obstruction treated by nasal ileus tube who were hospitalized from January 2018 to September 2022 in Jilin Provincial People’s Hospital were retrospectively analyzed and divided into 30 cases in the surgical group and 85 cases in the non-surgical group according to the treatment modality.Based on the patients’clinical data,multiple factors that may affect the surgical decision were screened and analyzed univariately,and the factors with statistical significance were subjected to multi-factor logistic regression analysis,while a logistic regression prediction model was established to evaluate its accuracy,sensitivity and specificity in predicting the surgical decision of tnasal ileus tube for mechanical intestinal obstruction.Results:the study showed that 9 factors,including a previous history of ileus,decreased bowel sounds,persistent abdominal pain>48 h,elevated white blood cell count(>10*10~9/L),ascitic fluid sign,mesenteric effusion sign,and depth of entry on the 1st day and 2 and 3 days before catheterization,were strongly associated with the determination of surgical decision for predicting mechanical ileus.Logistic regression analysis showed that a total of 4 factors were entered into the logistic regression equation:persistent abdominal pain>48h,elevated white blood cell count(>10*10~9/L),mesenteric effusion sign and depth of entry in the previous 2 days.Logistic regression prediction model was obtained as:P=1/(1+e~x)(x=7.704+2.834x3+2.569x4+2.967x6-0.195x8).The model predicted surgical decision-making for mechanical ileus treatment with a nasal ileus catheter with 86.96%accuracy,90.32%sensitivity,and 96.47%specificity.Conclusions:Persistent abdominal pain>48h,increased white blood cell count(>10*109/L),mesenteric effusion sign and the depth of ileus catheter entry on the second day after catheterization were predictive factors for the surgical decision of mechanical ileus treatment.The first three were independent risk factors,while the depth of ileus catheter entry on the second day was protective factors.The Logistic regression model established can better judge whether the patients with mechanical ileus need surgical treatment after nasal ileus catheter treatment.