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[阿里斯蒂德·勒丹泰克大学医院成年患者急诊腹部手术的围手术期管理]

[Perioperative management of emergency abdominal surgery in adult patients at the Aristide Le Dantec University Hospital].

作者信息

Gaye Ibrahima, Leye Pape Alassane, Traoré Mamadou Mour, Ndiaye Pape Ibrahima, Ba El Hadji Boubacar, Bah Mamadou Diawo, Fall Mouhamed Lamine, Diouf Elisabeth

机构信息

Service d'Anesthésie-Réanimation CHU Le Dantec, Faculté de Médecine UCAD, Dakar, Sénégal.

Service d'Anesthésie-Réanimation HEAR de Fann, Faculté de Médecine UCAD, Dakar, Sénégal.

出版信息

Pan Afr Med J. 2016 Jul 1;24:190. doi: 10.11604/pamj.2016.24.190.9929. eCollection 2016.

Abstract

Perioperative management of emergency abdominal surgery remains a major concern for anesthesiologists due to hemodynamic and/or metabolic disorders often present preoperatively as well as to potential postoperative complications. This study aims to evaluate the epidemiological, diagnostic, therapeutic and prognostic factors of abdominal emergencies. We conducted a retrospective descriptive study involving patients over 16 years old undergoing emergency abdominal surgery at the Aristide Le Dantec University Hospital over a period of six months. The parameters studied were the epidemiological, diagnostic, therapeutic and prognostic factors of emergency abdominal surgery. We collected 161 cases, nearly 20% of the activity in the department. The average age was 41 years [16, 80 years]. The sex ratio was 2.9. The mean consultation time was 4.6 days. Peritonitis was the most frequent pathologies (25.5%). The average heart rate in patients was 92 bpm (beats/ min) and 97 bpm in patients who underwent preoperative hemodynamic preparation. The average Mean Arterial Pressure (MAP) was 96.6 mmHg and 86.1 mmHg in prepared patients. 49.1% of patients were ASA class 1, 39.9% were ASA2, 8.7% ASA3, 2.5% ASA4 and 0.6% ASA5. Antibiotic prophylaxis was used in 46.30% of patients and 53.41% of them underwent antibiotic therapy. 95.6% of patients underwent general anesthesia and 4.4% underwent spinal anesthesia. The frequency of perioperative incidents was 11.08%. Morbidity was 4.3% and mortality was 4.96%. The management of emergency abdominal surgery requires a multidisciplinary approach that involves anesthetists, surgeons and biologists to further reduce morbidity and mortality rate which remains significant even today.

摘要

由于术前常出现血流动力学和/或代谢紊乱以及潜在的术后并发症,急诊腹部手术的围手术期管理仍然是麻醉医生主要关注的问题。本研究旨在评估腹部急症的流行病学、诊断、治疗和预后因素。我们进行了一项回顾性描述性研究,纳入了在六个月内于阿里斯蒂德·勒丹泰克大学医院接受急诊腹部手术的16岁以上患者。研究的参数为急诊腹部手术的流行病学、诊断、治疗和预后因素。我们收集了161例病例,占该科室业务量的近20%。平均年龄为41岁[16, 80岁]。男女比例为2.9。平均会诊时间为4.6天。腹膜炎是最常见的病症(25.5%)。患者的平均心率为92次/分钟,术前接受血流动力学准备的患者平均心率为97次/分钟。准备充分的患者平均动脉压(MAP)为96.6 mmHg,未充分准备的患者为86.1 mmHg。49.1%的患者为ASA 1级,39.9%为ASA2级,8.7%为ASA3级,2.5%为ASA4级,0.6%为ASA5级。46.30%的患者使用了抗生素预防,其中53.41%的患者接受了抗生素治疗。95.6%的患者接受全身麻醉,4.4%的患者接受脊髓麻醉。围手术期事件的发生率为11.08%。发病率为4.3%,死亡率为4.96%。急诊腹部手术的管理需要多学科方法,涉及麻醉医生、外科医生和生物学家,以进一步降低发病率和死亡率,即使在今天,发病率和死亡率仍然很高。

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