Sheu Bor-Fuh, Chiu Te-Fa, Chen Jih-Chang, Tung Meng-Sheng, Chang Meng-Wei, Young Yui-Rwei
Department of Emergency Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.
ANZ J Surg. 2007 Aug;77(8):662-6. doi: 10.1111/j.1445-2197.2007.04182.x.
The aim of this study was to identify factors associated with rupture in elderly patients with acute appendicitis.
The medical records of 601 consecutive patients >60 years of age with acute appendicitis between 1995 and 2005 were retrospectively reviewed. Historical, clinical and laboratory factors in patients with both intact and ruptured appendices were examined with univariate and multivariate analyses by logistic regressions.
Nine factors predicted appendiceal rupture age (odds ratio (OR) 1.05, confidence interval (CI) 1.02-1.07), male sex (OR 1.96, CI 1.35-2.06), preadmission duration of pain (OR 1.23, CI 1.11-1.36), interval of time from admission to surgery (OR 1.02, CI 1.01-1.04), fever >38 degrees C (OR 2.59, CI 1.78-3.77), left shift in leucocyte count >76% (OR 2.34, CI 1.27-4.32), anorexia (OR 2.03, CI 1.38-2.99) and a retrocaecally positioned appendix (OR 1.93, CI 1.15-3.24).
The incidence of appendiceal rupture, or complications secondary to appendiceal rupture, in elderly patients may be decreased if surgery is expedited when the temperature is >38 degrees C or there is a left shift in leucocyte count >76%, especially in men with anorexia.
本研究旨在确定老年急性阑尾炎患者阑尾破裂的相关因素。
回顾性分析1995年至2005年间601例年龄大于60岁的连续急性阑尾炎患者的病历。对阑尾完整和破裂患者的病史、临床及实验室因素进行单因素和多因素logistic回归分析。
九个因素可预测阑尾破裂：年龄（比值比（OR）1.05，置信区间（CI）1.02 - 1.07）、男性（OR 1.96，CI 1.35 - 2.06）、入院前疼痛持续时间（OR 1.23，CI 1.11 - 1.36）、入院至手术的时间间隔（OR 1.02，CI 1.01 - 1.04）、体温>38℃（OR 2.59，CI 1.78 - 3.77）、白细胞计数左移>76%（OR 2.34，CI 1.27 - 4.32）、厌食（OR 2.03，CI 1.38 - 2.99）及阑尾位于盲肠后位（OR 1.93，CI 1.15 - 3.24）。
如果在体温>38℃或白细胞计数左移>76%时加快手术，尤其是对伴有厌食的男性患者，老年患者阑尾破裂或阑尾破裂继发并发症的发生率可能会降低。
