Wahl W, Minkus A, Junginger T
Klinik und Poliklinik für Allgemein- und Abdominalchirurgie, Johannes Gutenberg-Universität, Mainz.
Langenbecks Arch Chir. 1992;377(4):237-43. doi: 10.1007/BF00210281.
From 1.1.1982-30.9.1989 280 patients were treated for intraabdominal infection at the clinic for general and abdominal surgery. With regard to their prognostic significance, the extent and localization of the peritonitis, abscess formation, the number of failed organ system, patients' age, total protein, thrombocytes and leucocytes were examined in these patients. The most unfavorable prognosis showed diffuse peritonitis with a mortality rate of 47.2%. Subsequent abscessing worsened the prognosis of the illness. There was a close correlation between the number of failed organ systems at the time of hospitalization and mortality. Low total protein content or more so a necessary substitution therapy were linked to a high mortality (less than 4 g%: 81.2% mortality). A low number of thrombocytes and leucocytes and a low total protein in the serum were a sure sign for a complicated process of the illness, with these 2 situations combined, mortality was 100%. The indication for laparotomy and most of all for relaparotomy can be facilitated, if these factors are included in the decision, as their negative change are an indicator for a further existing or imminent postoperative peritonitis.
1982年1月1日至1989年9月30日期间,普通外科和腹部外科诊所对280例腹腔内感染患者进行了治疗。针对这些患者,研究了腹膜炎的范围和部位、脓肿形成、器官系统功能衰竭的数量、患者年龄、总蛋白、血小板和白细胞等指标的预后意义。最不利的预后情况是弥漫性腹膜炎,死亡率为47.2%。随后出现脓肿会使病情预后恶化。住院时器官系统功能衰竭的数量与死亡率密切相关。总蛋白含量低,或者更确切地说是必要的替代疗法,与高死亡率相关(低于4g%:死亡率为81.2%)。血小板和白细胞数量低以及血清总蛋白含量低是疾病复杂过程的明确迹象,这两种情况同时出现时,死亡率为100%。如果在决策过程中考虑这些因素,开腹手术尤其是再次开腹手术的指征可以更容易确定,因为这些因素的负面变化表明存在进一步的术后腹膜炎或即将发生术后腹膜炎。