Systemic inflammation worsens outcomes in emergency surgical patients
Systemic inflammation worsens outcomes in emergency surgical patients
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DOI：
10.1097/ta.0b013e3182516a97
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发表时间：
2012-05-01
影响因子：
3.4
通讯作者：
Chang, Michael C.
中科院分区：
文献类型：
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作者：
Becher, Robert D.;Hoth, J. Jason;Chang, Michael C.
背景：急症外科医生独特地意识到全身炎症反应的重要性及其对术后结果的影响；诸如损害控制之类的概念就是从这种经验中演变而来的。对于主要是选择性执业的外科医生来说，这种全身性炎症的重要性可能被低估。本研究旨在确定术前全身炎症对需要紧急结肠手术的患者术后结果的影响。方法：美国外科医生学会国家外科质量改进计划 2008 年数据集中确定了紧急结直肠手术。根据术前炎症反应的存在和程度来定义四组：无炎症、全身炎症反应综合征（SIRS）、败血症或严重败血症/败血性休克。采用Kaplan-Meier法分析30天生存率。结果：总共确定了3,305名患者。四组之间的 30 天生存率存在显着差异 (p < 0.0001)；术前炎症程度的增加导致死亡概率增加（p < 0.0001）。风险比表明，与术前无全身炎症的患者相比，SIRS 死亡的相对风险为 1.9 (p < 0.0001)，脓毒症死亡的相对风险为 2.5 (p < 0.0001)，严重脓毒症/感染性休克死亡的相对风险为 6.7 (p < 0.0001)。 < 150 分钟的手术时间与发病风险降低相关（比值比 = 0.64；p < 0.0001）。结论：全身炎症反应的上调是急诊手术患者死亡的主要原因。对于 SIRS 或脓毒症患者，手术时间 < 2.5 小时与术后并发症较少有关。这些结果进一步强化了及时手术干预的概念，并表明损伤控制操作在急诊普通外科中的潜在作用。 （J Trauma。2012 年；72：1140-1149。版权所有 (C) 2012，Lippincott Williams & Wilkins）
BACKGROUND: Acute care surgeons are uniquely aware of the importance of systemic inflammatory response and its influence on postoperative outcomes; concepts like damage control have evolved from this experience. For surgeons whose practice is mostly elective, the significance of such systemic inflammation may be underappreciated. This study sought to determine the influence of preoperative systemic inflammation on postoperative outcome in patients requiring emergent colon surgery.METHODS: Emergent colorectal operations were identified in the American College of Surgeons National Surgical Quality Improvement Program 2008 dataset. Four groups were defined by the presence and magnitude of the inflammatory response before operation: no inflammation, systemic inflammatory response syndrome (SIRS), sepsis, or severe sepsis/septic shock. Thirty-day survival was analyzed by Kaplan-Meier method.RESULTS: A total of 3,305 patients were identified. Thirty-day survival was significantly different (p < 0.0001) among the four groups; increasing magnitudes of preoperative inflammation had increasing probability of mortality (p < 0.0001). Hazard ratios indicated that, compared with patients without preoperative systemic inflammation, the relative risk of death from SIRS was 1.9 (p < 0.0001), from sepsis was 2.5 (p < 0.0001), and from severe sepsis/septic shock was 6.7 (p < 0.0001). Operative time of < 150 minutes was associated with decreased risk of morbidity (odds ratio = 0.64; p < 0.0001).CONCLUSIONS: Upregulation of the systemic inflammatory response is the primary contributor to death in emergency surgical patients. In SIRS or sepsis patients, operations < 2.5 hours are associated with fewer postoperative complications. These results further reinforce the concept of timely surgical intervention and suggest a potential role for damage control operations in emergency general surgery. (J Trauma. 2012; 72: 1140-1149. Copyright (C) 2012 by Lippincott Williams & Wilkins)