在紧急一般外科手术中,在腹部内污染后,腹部开放
Ikemsinachi C Nzenwa1, Wardah Rafaqat1, May Abiad1
1Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
在急诊一般手术中延迟关闭 (DFC) 与腹腔内污染增加了死亡率和发病率. 立即关闭 (IFC) 与更好的结果有关,这表明DFC在这些情况下可能不有益.
科学领域:
- 外科手术的结果
- 紧急情况一般外科手术
- 腹部手术 腹部手术
背景情况:
- 延迟关闭 (DFC) 越来越多地用于紧急整体手术 (EGS).
- 关于DFC在EGS中具有腹腔内污染的益处的证据有限.
- 这项研究在这个患者群体中比较DFC与立即关闭 (IFC).
研究的目的:
- 为了比较DFC和IFC在EGS患者的临床结果与腹腔内污染.
- 评估DFC对死亡率,发病率和住院时间的影响.
主要方法:
- 美国外科医生学院2013-2020年国家外科质量改进计划数据库的回顾性分析.
- 包括成年EGS患者进行探索性腹腔切除术,受污染或脏的伤口.
- 倾向匹配分析比较DFC和IFC,以30天死亡率为主要结果.
主要成果:
- 在36974名符合条件的患者中,16.8%接受了DFC. 在匹配了6213对后,DFC与较高的死亡率 (15.8%与14.2%相比),肺炎和肺栓塞有关.
- 接受DFC的患者经历了更长的住院时间 (11天而不是10天).
- 没有发现术后败血症或深部手术部位感染率的显著差异;DFC在分炎子组中显示死亡率更高.
结论:
- 在腹腔内污染的EGS中,DFC与增加住院时间,死亡率和发病率有关.
- 与IFC相比,DFC没有减少传染性并发症.
- 需要进行进一步的研究,以确定受污染的腹部伤口中DFC的明确迹象.
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