Schneider Christian P, Seyboth Carol, Vilsmaier Markus, Küchenhoff Helmut, Hofner Benjamin, Jauch Karl-Walter, Hartl Wolfgang H
Department of Surgery, Klinikum Grosshadern, Marchioninistr. 15, 81377, Munich, Germany.
World J Surg. 2009 Jan;33(1):34-43. doi: 10.1007/s00268-008-9805-4.
Acute mortality of unselected critically ill patients has improved during the last 15 years. Whether these benefits also affect survival of critically ill patients with secondary peritonitis is unclear as is the relevance of specific prognostic factors, such as source control.
We performed a retrospective analysis of data collected prospectively from March 1993 to February 2005. A cohort of 319 consecutive postoperative patients with secondary peritonitis requiring intensive care was evaluated. End points for outcome analysis were derived from daily changes of hazard rate.
Four-month survival rate after intensive care unit (ICU) admission was 31.7%. For patients who have survived for more than 4 months, the 1-year survival was 82.7%. After adjustment for relevant covariates, a high disease severity at ICU admission and during ICU stay, specific comorbidities (extended malignancies, liver cirrhosis) and sources of infection (distal esophagus, stomach), and an inadequate initial antibiotic therapy were associated with worse 4-month prognosis. Inability to obtain source control was the most important determinant of mortality, and treatment after 2002 was combined with improved prognosis.
Four-month prognosis of critically ill, surgical patients with secondary peritonitis is poor and mostly determined by the ability to obtain source control. Outcome has improved since 2002, and after successful surgical and intensive care therapy long-term survival seems to be good.
在过去15年中，未经挑选的危重症患者的急性死亡率有所改善。这些益处是否也影响继发性腹膜炎危重症患者的生存率尚不清楚，特定预后因素（如源头控制）的相关性也不明确。
我们对1993年3月至2005年2月前瞻性收集的数据进行了回顾性分析。评估了一组319例连续术后发生继发性腹膜炎且需要重症监护的患者。结局分析的终点来自危险率的每日变化。
重症监护病房（ICU）入院后4个月生存率为31.7%。对于存活超过4个月的患者，1年生存率为82.7%。在对相关协变量进行调整后，ICU入院时和ICU住院期间疾病严重程度高、特定合并症（晚期恶性肿瘤、肝硬化）和感染源（食管远端、胃）以及初始抗生素治疗不足与4个月预后较差相关。无法实现源头控制是死亡率的最重要决定因素，2002年后的治疗与预后改善相关。
继发性腹膜炎危重症外科患者的4个月预后较差，主要取决于实现源头控制的能力。自2002年以来结局有所改善，在成功的手术和重症监护治疗后，长期生存率似乎良好。
