Damage Control Surgery for Non-traumatic Abdominal Emergencies
Damage Control Surgery for Non-traumatic Abdominal Emergencies
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DOI：
10.1007/s00268-017-4262-6
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发表时间：
2018-04-01
影响因子：
2.6
通讯作者：
Arvieux, Catherine
中科院分区：
文献类型：
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作者：
Girard, Edouard;Abba, Julio;Arvieux, Catherine
损伤控制手术（DCS）是危重创伤患者管理的主要范式变化，并逐渐扩展到普通外科领域，但这方面的数据仍然很少。该研究的目的是评估DCS在普通外科急诊患者中的效果。2005年至2015年间，164名患者（104名男性，66岁）因非创伤性腹部急诊接受了DCS。实施DCS的决定是由至少一项创伤DCS标准的存在所触发的：低血压（< 70 mmHg），体温过低（< 35℃），酸中毒（pH < 7.25），凝血功能障碍（INR为1.7）和大量（bb50 RBC）输血。进行统计学检验以确定手术死亡率的危险因素。将观察到的结果与常用评分（APACHE II、POSSUM、P-POSSUM、SAPS II）预测的结果进行比较。急性肠系膜缺血（n = 68）、腹膜炎（n = 44）、胰腺炎（n = 28）、出血（n = 14）及其他（n = 10）行DCS。52例（32%）患者伴有腹膜间室综合征。74例（45%）患者死亡，150例（91%）患者出现并发症。在多变量分析中，年龄（p = 0.018）和INR ae 1.7 （p = 0.001）是死亡率的独立预测因子。1、2和ae3型DCS患者的死亡率分别为24%（13/55）、48%（22/46）和62%（39/63）。观察到的死亡率和评分预测的死亡率的比较表明，DCS的使用对整个队列以及胰腺炎和术后腹膜炎患者的生存有显著的好处。DCS可以挽救普通外科急诊危重病人的生命。腹膜炎和急性胰腺炎患者最适合采用DCS方法。
Damage control surgery (DCS) was a major paradigm change in the management of critically ill trauma patients and has gradually expanded in the general surgery arena, but data in this setting are still scarce. The study aim was to evaluate outcomes of DCS in patients with general surgery emergencies.Between 2005 and 2015, 164 patients (104 men, age 66) underwent DCS for non-traumatic abdominal emergencies. The decision to perform DCS was triggered by the presence of at least one trauma DCS criterion: hypotension (< 70 mmHg), hypothermia (< 35 A degrees C), acidosis (pH < 7.25), coagulopathy (INR ae 1.7) and massive (> 5 RBC) transfusion. Statistical tests were performed to identify risk factors for operative mortality. Observed outcomes were compared to those predicted by commonly employed scores (APACHE II, POSSUM, P-POSSUM, SAPS II).DCS was performed for acute mesenteric ischemia (n = 68), peritonitis (n = 44), pancreatitis (n = 28), bleeding (n = 14) and other (n = 10). Abdominal compartment syndrome was associated in 52 patients (32%). Seventy-four (45%) patients died and 150 patients (91%) experienced complications. On multivariate analysis, age (p = 0.018) and INR ae 1.7 (p = 0.001) were independent predictors of mortality. Mortality was 24% (13/55), 48% (22/46) and 62% (39/63) in patients with one, two and ae3 DCS criteria, respectively. Comparison of observed and score-predicted mortality suggested DCS use resulted in significant survival benefit of the whole cohort and of patients with pancreatitis and postoperative peritonitis.DCS can be lifesaving in critically ill patients with general surgery emergencies. Patients with peritonitis and acute pancreatitis are those who benefit most of the DCS approach.