French N P, Smith J, Edwards G B, Proudman C J
Faculty of Veterinary Science, University of Liverpool, Neston, Wirral, UK.
Equine Vet J. 2002 Jul;34(5):444-9. doi: 10.2746/042516402776117791.
The reason for undertaking this study was that postoperative complications of colic surgery lead to patient discomfort, prolonged hospitalisation and increased cost. Potential risk factors for the 6 most common postoperative complications (jugular thrombosis, ileus, re-laparotomy, wound suppuration, incisional herniation and colic) were evaluated using multivariable models. Jugular thrombosis was associated significantly with heart rate greater than 60 beats/min and with increased packed cell volume (PCV) at admission. The risk of postoperative ileus also increased with increasing PCV at admission and was higher in horses recovering from pedunculated lipoma obstruction. Incisional herniation was strongly associated with wound suppuration and with increasing heart rate at admission. The emergence of cardiovascular parameters as risk factors for several postoperative complications is consistent with the hypothesis that endotoxaemia is important in the development of these complications. Early referral of colic cases, prior to the development of severe endotoxaemic shock, may minimise the risk of some postoperative complications. Horses that have suffered epiploic foramen entrapment, are more than 4 times as likely to undergo re-laparotomy than other horses. Horses that have suffered postoperative ileus have a similarly increased risk of undergoing re-laparotomy. The risk of postoperative colic is significantly associated with horses recovering from large colon torsion (>360 degrees) and with having undergone re-laparotomy. Hazard ratios (with 95% confidence intervals) for these last two effects are 3.1 (1.7, 5.7) and 3.4 (1.9, 6.2), respectively. Knowledge of the risk factors for postoperative complications allows more accurate prognostication postoperatively and suggests ways in which the risk of postoperative complications can be minimised.
开展这项研究的原因是结肠手术的术后并发症会导致患者不适、住院时间延长和费用增加。使用多变量模型评估了6种最常见术后并发症（颈静脉血栓形成、肠梗阻、再次剖腹手术、伤口化脓、切口疝和绞痛）的潜在风险因素。颈静脉血栓形成与心率大于60次/分钟以及入院时血细胞比容（PCV）升高显著相关。术后肠梗阻的风险也随着入院时PCV的增加而增加，并且在从有蒂脂肪瘤梗阻恢复的马匹中更高。切口疝与伤口化脓以及入院时心率增加密切相关。心血管参数作为几种术后并发症的风险因素的出现与内毒素血症在这些并发症发生中起重要作用的假设一致。在严重内毒素血症休克发生之前尽早转诊绞痛病例，可能会将一些术后并发症的风险降至最低。患有网膜孔嵌顿的马匹接受再次剖腹手术的可能性是其他马匹的4倍多。患有术后肠梗阻的马匹接受再次剖腹手术的风险也同样增加。术后绞痛的风险与从大结肠扭转（>360度）恢复的马匹以及接受过再次剖腹手术显著相关。这最后两种影响的风险比（及其95%置信区间）分别为3.1（1.7，5.7）和3.4（1.9，6.2）。了解术后并发症的风险因素可以使术后预后更准确，并提示可将术后并发症风险降至最低的方法。
