Acute Physiological and Chronic Health Evaluation II Score and its Correlation with Three Surgical Strategies for Management of Ileal Perforations.
Acute Physiological and Chronic Health Evaluation II Score and its Correlation with Three Surgical Strategies for Management of Ileal Perforations.
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DOI：
10.4103/2006-8808.185653
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发表时间：
2015-07
期刊：
影响因子：
--
通讯作者：
Yadav M
中科院分区：
文献类型：
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作者：
Munghate A;Kumar A;Mittal S;Singh H;Sharma J;Yadav M
回肠穿孔腹膜炎是印度次大陆和热带国家常见的外科急症。据报道，根据急性生理和慢性健康评估II(APACHE II)评分，在这些治疗中，由于肠热和结核病的高发病率，它构成了腹部急救的第五大常见原因。以下研究是在帕蒂亚拉政府医学院普外科进行的。共有57例患者被分为I、II和III组。APACHE II评分在10~19分之间的患者被盲法随机分为三种术式：一期缝合术、切除吻合术和回肠造口术。并对结果进行比较。回肠穿孔在男性占主导地位的生命的第三和第四个十年最常见。APACHE II评分为0~9分6例，10~19分48例，≥评分20分3例。APACHE II评分10~19分，一期缝合15例，切除吻合术16例，回肠造口术17例。对于APACHE II评分为10-19的单个小穿孔(<；1 cm)的患者，无论穿孔持续时间长短，均建议一期缝合穿孔。在APACHE II评分10-19分中提倡回肠造口，回肠末端严重发炎，有多个穿孔、大穿孔(>；1厘米)、粪便腹膜炎、垫状肠环、术中有干酪化的淋巴结、狭窄和因浮肿导致的肠道不健康。
Ileal perforation peritonitis is a common surgical emergency in the Indian subcontinent and in tropical countries. It is reported to constitute the fifth common cause of abdominal emergencies due to high incidence of enteric fever and tuberculosis in these management based on Acute Physiological and Chronic Health Evaluation II (APACHE II) score. The following study was conducted in the Department of General Surgery, Government Medical College, Patiala. A total of 57 patients were studied and divided in to Group I, II, and III. APACHE II score accessed and score between 10 and 19 were blindly randomized into three procedures primary closure, resection-anastomosis, and ileostomy. The outcome was compared. Ileal perforations were most commonly observed in the third and fourth decade of life with male dominance. APACHE II score was accessed and out of total 57 patients, 6 patients had APACHE II score of 0–9, 48 patients had APACHE II score of 10–19, and 3 patients had APACHE II score of ≥20. In APACHE II score 10–19, 15 patients underwent primary closure, 16 patients underwent resection-anastomosis, and 17 patients underwent ileostomy. Primary closure of perforation is advocated in patients with single, small perforation (<1 cm) with APACHE II score 10–19 irrespective of duration of perforation. Ileostomy is advocated in APACHE II score 10–19, where the terminal ileum is grossly inflamed with multiple perforations, large perforations (>1 cm), fecal peritonitis, matted bowel loops, intraoperative evidence of caseating lymph nodes, strictures, and an unhealthy gut due to edema.