Vaughan-Shaw P G, Saunders J, Smith T, King A T, Stroud M A
University Hospital Southampton NHS Foundation Trust, UK.
Ann R Coll Surg Engl. 2013 Sep;95(6):390-6. doi: 10.1308/003588413X13629960046552.
Oedema is observed frequently following surgery and may be associated with worse outcomes. To date, no study has investigated the role of oedema in the emergency surgical patient. This study assesses the incidence of oedema following emergency abdominal surgery and the value of early postoperative oedema measurement in predicting clinical outcome.
A prospective cohort study of patients undergoing emergency abdominal surgery at a university unit over a two-month period was undertaken. Nutritional and clinical outcome data were collected and oedema was measured in the early postoperative period. Predictors of oedema and outcomes associated with postoperative oedema were identified through univariate and multivariate analysis.
Overall, 55 patients (median age: 66 years) were included in the study. Postoperative morbidity included ileus (n=22) and sepsis (n=6) with 12 deaths at follow-up. Postoperative oedema was present in 19 patients and was associated with prolonged perioperative fasting (107 vs 30 hours, p=0.009) but not with body mass index (24 kg/m(2) vs 27 kg/m(2), p=0.169) or preadmission weight loss (5% vs 3%, p=0.923). On multivariate analysis, oedema was independently associated with gastrointestinal recovery (B=6.91, p=0.038), artificial nutritional support requirement (odds ratio: 6.91, p=0.037) and overall survival (χ(2) =13.1, df=1, p=0.001).
Generalised oedema is common after emergency abdominal surgery and appears to independently predict gastrointestinal recovery, the need for artificial nutritional support and survival. Oedema is not associated with commonly applied markers of nutritional status such as body mass index or recent weight loss. Measurement of oedema offers utility in identifying those at risk of poor clinical outcome or those requiring artificial nutritional support following emergency abdominal surgery.
水肿在手术后经常出现，可能与更差的预后相关。迄今为止，尚无研究调查水肿在急诊手术患者中的作用。本研究评估急诊腹部手术后水肿的发生率以及术后早期水肿测量对预测临床结局的价值。
对一所大学单位在两个月期间接受急诊腹部手术的患者进行了一项前瞻性队列研究。收集了营养和临床结局数据，并在术后早期测量了水肿情况。通过单因素和多因素分析确定水肿的预测因素以及与术后水肿相关的结局。
总体而言，55例患者（中位年龄：66岁）纳入研究。术后并发症包括肠梗阻（n = 22）和脓毒症（n = 6），随访期间有12例死亡。19例患者出现术后水肿，与围手术期禁食时间延长相关（107小时对30小时，p = 0.009），但与体重指数（24kg/m²对27kg/m²，p = 0.169）或入院前体重减轻（5%对3%，p = 0.923）无关。多因素分析显示，水肿与胃肠道恢复独立相关（B = 6.91，p = 0.038）、人工营养支持需求（比值比：6.91，p = 0.037）和总体生存（χ² = 13.1，自由度 = 1，p = 0.001）。
急诊腹部手术后全身性水肿常见，似乎能独立预测胃肠道恢复、人工营养支持需求和生存情况。水肿与体重指数或近期体重减轻等常用营养状况指标无关。水肿测量有助于识别急诊腹部手术后临床结局差或需要人工营养支持的高危患者。
