Ahuja Ashish, Pal Ravinder
Assistant Professor, Department of Surgery, Dayanand Medical College & Hospital , Ludhiana, Punjab, India .
J Clin Diagn Res. 2013 Sep;7(9):1953-5. doi: 10.7860/JCDR/2013/6572.3375. Epub 2013 Sep 10.
Acute generalised peritonitis coming forth due to underlying intestinal perforation is a critical & life-threatening medical condition. It is a common surgical emergency most of the times across the world. Misleading data on crude morbidity and mortality due to the condition usually contaminates substantially the very purpose of medical audit. Thus, early prognostic evaluation is not only desirable but mandate to much extent. High-risk patients require timely & aggressive treatment especially in severe peritonitis & to select them reasonably well, evaluation through prognostic scoring is an approach of choice. Well sought after & reasonably reliable APACHE II scoring system is used for the purpose & scores are correlated well to accentuate & measure the various factors needed for better management of condition.
The study was conducted over the period of 18 months (Jan 2010 to June 2011) on 50 patients with confirmed diagnosis of intestinal perforation. APACHE II score was calculated and correlated with their symptoms & clinical outcomes regarding morbidity and mortality.
APACHE II score correlated well with the outcome of the study, showing score affects of two major aspects in the treatment outcome & management.1.) APACHE II score of less than 10 included 30 low risk group patients discharged in a satisfactory gratifying manner. Three out of four in high risk group with APACHE II score >20, shown adverse outcomes. 2.)Mean ICU stay of 9.75 days was found in patients with APACHE II score 20 or more compared to those with mean ICU stay of 0.13 days in patients with APACHE II score 10 or less.
Acute generalized peritonitis being life-threatening medical emergency requires careful consideration in its management that needs to be economically viable, acceptably feasible and outcome oriented with better allocation & utilization of ICU resources that needs meticulous case analysis & prioritization. This present study helps the clinicians in three major ways: a) To take better decisions on case to case basis; b) To design strategies in order to prevent adverse outcomes; c) Last but not least, to make better use of ICU resources.
由潜在的肠道穿孔引发的急性弥漫性腹膜炎是一种危急且危及生命的病症。在全球范围内，它大多时候都是常见的外科急症。由于该病症导致的粗略发病率和死亡率的误导性数据，通常会严重干扰医学审计的目的。因此，早期预后评估不仅是可取的，在很大程度上也是必要的。高危患者需要及时且积极的治疗，尤其是在重症腹膜炎的情况下，为了合理地挑选出这些患者，通过预后评分进行评估是首选方法。备受追捧且相当可靠的急性生理与慢性健康状况评分系统（APACHE II）被用于此目的，其分数与各种因素具有良好的相关性，以突出并衡量更好地管理该病症所需的各种因素。
本研究在18个月期间（2010年1月至2011年6月）对50例确诊为肠道穿孔的患者进行。计算急性生理与慢性健康状况评分系统（APACHE II）分数，并将其与患者的症状以及关于发病率和死亡率的临床结果相关联。
急性生理与慢性健康状况评分系统（APACHE II）分数与研究结果具有良好的相关性，表明该分数在治疗结果和管理方面影响两个主要方面。1.）急性生理与慢性健康状况评分系统（APACHE II）分数低于10分的30例低风险组患者以令人满意的方式出院。急性生理与慢性健康状况评分系统（APACHE II）分数>20分的高风险组中四分之三出现不良结果。2.）急性生理与慢性健康状况评分系统（APACHE II）分数为20分或更高的患者平均重症监护病房（ICU）住院时间为9.75天，而急性生理与慢性健康状况评分系统（APACHE II）分数为10分或更低的患者平均重症监护病房（ICU）住院时间为0.13天。
急性弥漫性腹膜炎作为危及生命的医疗急症，在其管理中需要仔细考虑，管理方式需要在经济上可行、可接受且可行，并以结果为导向，更好地分配和利用重症监护病房（ICU）资源，这需要细致的病例分析和优先级排序。本研究在三个主要方面帮助临床医生：a）逐案做出更好的决策；b）设计策略以预防不良结果；c）最后但同样重要的是，更好地利用重症监护病房（ICU）资源。
