Halpern N A, McElhinney A J, Greenstein R J
Department of Surgical Critical Care, VA Medical Center, Bronx, NY 10468.
Crit Care Med. 1991 Jul;19(7):882-6.
To determine if postoperative diagnostic abdominal paracentesis is a useful clinical tool in the abdominal evaluation of the critically ill septic patient.
Retrospective review.
Surgical ICU patients in a Veterans Administration medical center.
Ten patients were studied from a total of 1,053 patients admitted to the surgical ICU between September 1985 and May 1989.
Diagnostic abdominal paracentesis performed by the open or closed approaches.
Results are presented in three patient groups (A, B, and C): Group A (n = 4) had positive diagnostic abdominal paracentesis. Abdominal causes for the sepsis were found at reexploration. One of these four patients survived. Group B (n = 3) had negative diagnostic abdominal paracentesis. No abdominal septic source was found at reexploration; all three patients died. In group C (n = 3), diagnostic abdominal paracentesis was negative, patients were not reexplored, and all survived. Diagnostic accuracy correlated with three variables: a) the gross appearance and smell of the fluid, b) WBC count greater than 5000 or less than 500/mm3, and c) Gram stain demonstrating bacterial organisms.
Diagnostic abdominal paracentesis proved accurate, reliable, simple, safe, and rapid in evaluating the abdomen in the postoperative septic patient. The use of this procedure should be considered in postoperative septic patients in whom an abdominal source for the sepsis needs to be excluded.
确定术后诊断性腹腔穿刺术是否为评估重症脓毒症患者腹部情况的有用临床工具。
回顾性研究。
一家退伍军人管理局医疗中心的外科重症监护病房。
对1985年9月至1989年5月期间收入外科重症监护病房的1053例患者中的10例进行了研究。
采用开放或闭合方法进行诊断性腹腔穿刺术。
结果分为三组患者（A组、B组和C组）呈现：A组（n = 4）诊断性腹腔穿刺术结果为阳性。再次探查时发现了脓毒症的腹部病因。这4例患者中有1例存活。B组（n = 3）诊断性腹腔穿刺术结果为阴性。再次探查时未发现腹部脓毒症来源；所有3例患者均死亡。C组（n = 3）诊断性腹腔穿刺术结果为阴性，未对患者进行再次探查，所有患者均存活。诊断准确性与三个变量相关：a）液体的外观和气味，b）白细胞计数大于5000或小于500/mm³，c）革兰氏染色显示有细菌。
诊断性腹腔穿刺术在评估术后脓毒症患者的腹部情况时被证明准确、可靠、简单、安全且快速。对于需要排除脓毒症腹部来源的术后脓毒症患者，应考虑采用此检查方法。
