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犬类胃肠道手术后感染性腹膜炎及死亡风险因素的识别。

Identification of risk factors for septic peritonitis and failure to survive following gastrointestinal surgery in dogs.

作者信息

Grimes Janet A, Schmiedt Chad W, Cornell Karen K, Radlinksy Mary Ann G

机构信息

Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, GA 30602, USA.

出版信息

J Am Vet Med Assoc. 2011 Feb 15;238(4):486-94. doi: 10.2460/javma.238.4.486.

Abstract

OBJECTIVE

To identify risk factors for failure to survive and development of septic peritonitis following full-thickness gastrointestinal incision in dogs. Design-Retrospective cohort study.

ANIMALS

Dogs that underwent gastrointestinal surgery from 1998 through 2007 at the University of Georgia Veterinary Teaching Hospital. Procedures-Medical records of dogs undergoing a full-thickness gastrointestinal incision were reviewed, and information regarding dog history, clinicopathologic findings, surgery characteristics, and outcome was collected.

RESULTS

Records for 197 dogs (225 surgeries) were evaluated. In 35 (16%) surgeries, the dogs died prior to hospital discharge. After 28 (12%) surgeries, dogs developed septic peritonitis. For 45 (20%) surgeries, dogs had preoperative septic peritonitis; of those, approximately a third resulted in continued septic peritonitis (17/45; 38%) or death (15/45; 33%). Of the 180 surgeries performed in dogs lacking preoperative septic peritonitis, 11 (6%) resulted in development of septic peritonitis and 20 (11 %) resulted in death. When all surgeries were considered, common risk factors for development of septic peritonitis included preoperative septic peritonitis, low preoperative serum albumin and plasma protein concentrations, and intraoperative hypotension. Presence of a foreign body was a protective factor.

CONCLUSIONS AND CLINICAL RELEVANCE

Multiple factors were associated with failure to survive and development of septic peritonitis after gastrointestinal surgery in dogs. Aggressive perioperative attempts to increase protein concentrations and intraoperative surgical strategies to decrease the chance of a poor outcome may be indicated in dogs with risk factors identified in this study.

摘要

目的

确定犬全层胃肠道切开术后死亡及发生化脓性腹膜炎的危险因素。设计-回顾性队列研究。

动物

1998年至2007年在佐治亚大学兽医教学医院接受胃肠道手术的犬。程序-回顾接受全层胃肠道切开术的犬的病历,并收集有关犬病史、临床病理检查结果、手术特征及预后的信息。

结果

评估了197只犬(225次手术)的记录。在35次(16%)手术中,犬在出院前死亡。28次(12%)手术后,犬发生了化脓性腹膜炎。45次(20%)手术的犬术前患有化脓性腹膜炎;其中,约三分之一导致持续化脓性腹膜炎(17/45;38%)或死亡(15/45;33%)。在术前无化脓性腹膜炎的犬所进行的180次手术中,11次(6%)发生了化脓性腹膜炎,20次(11%)导致死亡。当考虑所有手术时,发生化脓性腹膜炎的常见危险因素包括术前化脓性腹膜炎、术前血清白蛋白和血浆蛋白浓度低以及术中低血压。异物的存在是一个保护因素。

结论及临床意义

多种因素与犬胃肠道手术后死亡及化脓性腹膜炎的发生有关。对于本研究中确定有危险因素的犬,围手术期积极提高蛋白浓度及术中采取手术策略以降低不良预后的可能性可能是必要的。

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