Sharma Smita S, Mamtani Manju R, Sharma Mamta S, Kulkarni Hemant
Department of Surgery, Indira Gandhi Government Medical College, Nagpur, India.
BMC Surg. 2006 Jun 16;6:8. doi: 10.1186/1471-2482-6-8.
With dwindling rates of postoperative mortality in perforated peptic ulcer that is attributable to H2-receptor blocker usage, there is a need to shift the focus towards the prevention of postoperative morbidity. Further, the simultaneous contribution of several putative clinical predictors to this postoperative morbidity is not fully appreciated. Our objective was to assess the predictors of the risk, rate and number of postoperative complications in surgically treated patients of perforated peptic ulcer.
In a prospective cohort study of 96 subjects presenting as perforated peptic ulcer and treated using Graham's omentoplatsy patch or gastrojejunostomy (with total truncal vagotomy), we assessed the association of clinical predictors with three domains of postoperative complications: the risk of developing a complication, the rate of developing the first complication and the risk of developing higher number of complications. We used multiple regression methods - logistic regression, Cox proportional hazards regression and Poisson regression, respectively - to examine the association of the predictors with these three domains.
We observed that the risk of developing a postoperative complication was significantly influenced by the presence of a concomitant medical illness [odds ratio (OR) = 8.9, p = 0.001], abdominal distension (3.8, 0.048) and a need of blood transfusion (OR = 8.2, p = 0.027). Using Poisson regression, it was observed that the risk for a higher number of complications was influenced by the same three factors [relative risk (RR) = 2.6, p = 0.015; RR = 4.6, p < 0.001; and RR = 2.4, p = 0.002; respectively]. However, the rate of development of complications was influenced by a history suggestive of shock [relative hazards (RH) = 3.4, p = 0.002] and A- blood group (RH = 4.7, p = 0.04).
Abdominal distension, presence of a concomitant medical illness and a history suggestive of shock at the time of admission warrant a closer and alacritous postoperative management in patients of perforated peptic ulcer.
随着因使用H2受体阻滞剂导致的穿孔性消化性溃疡术后死亡率的下降，有必要将重点转向预防术后并发症。此外，几种假定的临床预测因素对这种术后并发症的共同作用尚未得到充分认识。我们的目的是评估穿孔性消化性溃疡手术治疗患者术后并发症的风险、发生率和数量的预测因素。
在一项对96例表现为穿孔性消化性溃疡并采用格雷厄姆大网膜修补术或胃空肠吻合术（加全胃迷走神经切断术）治疗的受试者进行的前瞻性队列研究中，我们评估了临床预测因素与术后并发症三个方面的关联：发生并发症的风险、出现首次并发症的发生率以及出现更多并发症的风险。我们分别使用多元回归方法——逻辑回归、Cox比例风险回归和泊松回归——来检验预测因素与这三个方面的关联。
我们观察到，合并内科疾病（比值比[OR]=8.9，p=0.001）、腹胀（3.8，0.048）和需要输血（OR=8.2，p=0.027）显著影响术后发生并发症的风险。使用泊松回归观察到，相同的三个因素影响发生更多并发症的风险[相对风险（RR）=2.6，p=0.015；RR=4.6，p<0.001；RR=2.4，p=0.002]。然而，并发症的发生速度受提示休克的病史[相对风险（RH）=3.4，p=0.002]和A型血（RH=4.7，p=0.04）影响。
对于穿孔性消化性溃疡患者，腹胀、合并内科疾病以及入院时提示休克的病史需要在术后进行更密切和迅速的管理。
