Munaco Anthony J, Veenstra Michelle A, Brownie Evan, Danielson Logan A, Nagappala Kartheek B, Klein Michael D
Department of Pediatric Surgery, The Children's Hospital of Michigan, Detroit, Michigan, USA.
Am Surg. 2015 May;81(5):438-43.
Up to half of all patients with necrotizing enterocolitis require acute surgical treatment. Determining when to operate on these patients can be challenging. Utilizing a combination of clinical and metabolic indicators, we sought to identify the optimal timing of surgical intervention. A retrospective chart review was conducted on patients with necrotizing enterocolitis from 2001 to 2010. Previously validated clinical (abdominal erythema, palpable abdominal mass, hypotension), radiographic (pneumoperitoneum, portal venous gas, fixed bowel loop, severe pneumatosis intestinalis), and laboratory (acidosis, bacteremia, hyponatremia, bandemia, neutropenia, thrombocytopenia) indicators were assessed for the ability to predict the need for acute surgical intervention as a simple indicator score, based on the sum of the indicators listed above. A total of 197 patients were included. One hundred and twenty-four procedures (28 peritoneal drains, 96 laparotomy) were performed on 122 patients (62%). Median indicator score was 4 (range: 0-8). Logistic regression identified abdominal erythema (odds ratio [OR] = 3.3, P = 0.001), acidosis (OR = 2.6, P = 0.004), and hypotension (OR = 1.9, P = 0.05) as independently associated with surgical intervention. A significant increase in surgical intervention was noted for patients with indicator score of 3 or more. In conclusion, if three or more indicators exist, operative intervention is very likely required. In the absence of pneumoperitoneum, abdominal erythema, acidosis, and hypotension are especially important.
高达半数的坏死性小肠结肠炎患者需要进行急诊手术治疗。确定这些患者的手术时机具有挑战性。我们利用临床和代谢指标相结合的方法，试图确定手术干预的最佳时机。对2001年至2010年期间患有坏死性小肠结肠炎的患者进行了回顾性病历审查。评估了先前经验证的临床指标（腹部红斑、可触及的腹部肿块、低血压）、影像学指标（气腹、门静脉积气、固定肠袢、严重肠壁积气）和实验室指标（酸中毒、菌血症、低钠血症、杆状核细胞增多、中性粒细胞减少、血小板减少）作为简单指标评分预测急诊手术干预需求的能力，该评分基于上述指标的总和。共纳入197例患者。122例患者（62%）接受了124次手术（28次腹腔引流、96次剖腹手术）。指标评分中位数为4（范围：0 - 8）。逻辑回归分析确定腹部红斑（比值比[OR]=3.3，P = 0.001）、酸中毒（OR = 2.6，P = 0.004）和低血压（OR = 1.9，P = 0.05）与手术干预独立相关。指标评分为3分或更高的患者手术干预显著增加。总之，如果存在三个或更多指标，很可能需要进行手术干预。在没有气腹的情况下，腹部红斑、酸中毒和低血压尤为重要。
