重症监护患者的结肠切除术：手术发现和结果。

Colectomy in intensive care patients: operative findings and outcomes.

机构信息

Department of Anaesthesiology, Division of Intensive Care Medicine, Oulu University Hospital, P.O. Box 21, 90029 Oulu, Finland.

出版信息

World J Surg. 2013 Feb;37(2):333-8. doi: 10.1007/s00268-012-1836-1.

DOI:10.1007/s00268-012-1836-1

PMID:23142989

Abstract

BACKGROUND

With a critical illness, intestinal complications are associated with high morbidity and mortality.

METHODS

Operative findings and outcomes of 77 intensive care unit (ICU) patients treated with colectomy are described.

RESULTS

Three conditions led to colectomy: sepsis (S group; n = 31), fulminant Clostridium difficile colitis (Cl group; n = 25), and cardiovascular surgery (CV group; n = 21). The median Acute Physiology and Chronic Health score was >25 in all groups. Thickening and distension of the colon was more frequent in the Cl group (p = 0.001), and ischemia was more frequent in the S and CV groups (p < 0.001). Widespread necrosis was more frequent in the CV patients (p = 0.001). The kappa value for ischemic operative findings and histologic necrosis was 0.64 (95 % confidence interval 0.49-0.79). Hospital mortality was 35 % without multiple organ failure (MOF) (n = 31) and 74 % with MOF (n = 46) (p < 0.001). Overall, 38 % were alive at the 1-year follow-up.

CONCLUSIONS

Although colectomy in ICU patients is associated with high hospital mortality, patients who survive beyond their hospital stay have a good 1-year outcome.

摘要

背景

患有重病的患者，其肠道并发症与高发病率和死亡率相关。

方法

描述了 77 例在重症监护病房（ICU）接受结肠切除术治疗的 ICU 患者的手术发现和结果。

结果

三种情况导致了结肠切除术：脓毒症（S 组；n = 31）、暴发性艰难梭菌结肠炎（Cl 组；n = 25）和心血管手术（CV 组；n = 21）。所有组的急性生理学和慢性健康评分中位数均>25。Cl 组的结肠增厚和扩张更为频繁（p = 0.001），S 组和 CV 组的缺血更为频繁（p < 0.001）。CV 患者的广泛坏死更为频繁（p = 0.001）。缺血手术发现和组织坏死的kappa 值为 0.64（95 %置信区间 0.49-0.79）。无多器官功能衰竭（MOF）的患者（n = 31）的住院死亡率为 35 %，而有 MOF 的患者（n = 46）的住院死亡率为 74 %（p < 0.001）。总体而言，1 年后有 38 %的患者存活。