Thacker Lauren K, Parks Jennifer, Thal Erwin R
Department of Surgery, Division of Burns, Trauma and Critical Care, University of Texas Southwestern Medical School, Texas, USA.
J Trauma. 2007 Apr;62(4):853-7. doi: 10.1097/TA.0b013e31803245d9.
Controversy exists regarding the interpretation of diagnostic peritoneal lavage results. This is especially true in the evaluation of patients sustaining penetrating trauma, specifically stab wounds to the lower chest and abdomen. Ideally one wants to avoid missed injuries and minimize unnecessary operations.
This is a retrospective review of 195 patients sustaining stab wounds to the anterior lower chest and abdomen at Parkland Memorial Hospital between 1993 and 2005, looking at missed injuries and false positive rates using red cell counts of 100,000, 10,000, and the standard criteria for blunt trauma including >500 white blood cells (WBCs), amylase, and/or bile.
The first analysis used >100,000 red blood cells (RBCs)/mm3 as a positive value. The false positive rate was 12.2%. The second analysis used >10,000 RBCs/mm3 as a positive value with a false positive rate of 44%. When considering the entire study population (195 patients), the false positive rate increased when using the lower number (>10,000) from 2.5% to 15.8% (p < 0.001). There were no missed injuries when using >100,000 red cells and/or >500 white cells, the presence of bile or amylase.
Decreasing the red blood cell count from >100,000 to >10,000 as the criteria for operating on patients with stab wounds to the anterior lower chest and/or abdomen will significantly increase the number of nontherapeutic procedures. Based on this study, >100,000 RBCs/mm3 appears to be a valid and safe number to use when evaluating these patients, particularly when used with other positive criteria such as increased white cells, bile, and amylase.
对于诊断性腹腔灌洗结果的解读存在争议。在评估穿透性创伤患者，尤其是下胸部和腹部刺伤患者时，情况更是如此。理想情况下，人们希望避免漏诊损伤并尽量减少不必要的手术。
这是一项对195例于1993年至2005年间在帕克兰纪念医院遭受下胸部和腹部前侧刺伤患者的回顾性研究，观察漏诊损伤情况以及使用100,000、10,000的红细胞计数和钝性创伤的标准标准（包括>500个白细胞（WBC）、淀粉酶和/或胆汁）时的假阳性率。
首次分析将>100,000个红细胞（RBC）/mm3作为阳性值。假阳性率为12.2%。第二次分析将>10,000个RBC/mm3作为阳性值，假阳性率为44%。在考虑整个研究人群（195例患者）时，使用较低数值（>10,000）时假阳性率从2.5%增加到15.8%（p<0.001）。使用>100,000个红细胞和/或>500个白细胞、胆汁或淀粉酶存在时没有漏诊损伤。
将下胸部和/或腹部前侧刺伤患者手术标准的红细胞计数从>100,000降至>10,000将显著增加非治疗性手术的数量。基于这项研究，>100,000个RBC/mm3在评估这些患者时似乎是一个有效且安全的数值，特别是与其他阳性标准如白细胞增加、胆汁和淀粉酶一起使用时。
