人类免疫缺陷病毒状态对穿透性腹部创伤预后的影响：一项中期分析。

The Effect of Human-Immunodeficiency Virus Status on Outcomes in Penetrating Abdominal Trauma: An Interim Analysis.

作者信息

McPherson Deidre, Neuhaus Valentin, Dhar Rohin, Edu Sorin, Nicol Andrew J, Navsaria Pradeep H

机构信息

Trauma Center, Department of Surgery, Groote Schuur Hospital, University of Cape Town, Observatory, Cape Town, 7925, South Africa.

出版信息

World J Surg. 2018 Aug;42(8):2412-2420. doi: 10.1007/s00268-018-4502-4.

DOI:10.1007/s00268-018-4502-4

PMID:29387958

Abstract

BACKGROUND

The purpose of this study was to determine whether the outcomes of hemodynamically stable patients undergoing exploratory laparotomy for penetrating abdominal trauma differed as a result of their HIV status.

METHODS

This was an observational, prospective study from February 2016 to May 2017. All hemodynamically stable patients with penetrating abdominal trauma requiring a laparotomy were included. The mechanism of injury, the HIV status, age, the penetrating abdominal trauma index (PATI), and the revised trauma score (RTS) were entered into a binary logistic regression model. Outcome parameters were in-hospital death, morbidity, admission to intensive care unit (ICU), relaparotomy within 30 days, and length of stay longer than 30 days.

RESULTS

A total of 209 patients, 94% male, with a mean age of 29 ± 10 years were analysed. Twenty-eight patients (13%) were HIV positive. The two groups were comparable. Ten (4.8%) laparotomies were negative. There were two (0.96%) deaths, both in the HIV negative group. The complication rate was 34% (n = 72). Twenty-nine patients (14%) were admitted to the ICU. A higher PATI, older age, and a lower RTS were significant risk factors for ICU admission. After 30 days, 12 patients (5.7%) were still in hospital. Twenty-four patients (11%) underwent a second laparotomy. The PATI score was the single independent predictor for complications, relaparotomy, and hospital stay longer than 30 days.

CONCLUSIONS

Preliminary results reveal that HIV status does not influence outcomes in patients with penetrating abdominal trauma.

摘要

背景

本研究旨在确定因穿透性腹部创伤接受剖腹探查术的血流动力学稳定患者的预后是否因其HIV感染状况而有所不同。

方法

这是一项于2016年2月至2017年5月进行的观察性前瞻性研究。纳入所有因穿透性腹部创伤需要进行剖腹探查术且血流动力学稳定的患者。将损伤机制、HIV感染状况、年龄、穿透性腹部创伤指数（PATI）和修订创伤评分（RTS）纳入二元逻辑回归模型。结局参数包括院内死亡、发病率、入住重症监护病房（ICU）、30天内再次剖腹手术以及住院时间超过30天。

结果

共分析了209例患者，其中94%为男性，平均年龄为29±10岁。28例患者（13%）为HIV阳性。两组具有可比性。10例（4.8%）剖腹手术结果为阴性。有2例（0.96%）死亡，均在HIV阴性组。并发症发生率为34%（n = 72）。29例患者（14%）入住ICU。较高的PATI、较高的年龄和较低的RTS是入住ICU的显著危险因素。30天后，12例患者（5.7%）仍住院。24例患者（11%）接受了二次剖腹手术。PATI评分是并发症、再次剖腹手术和住院时间超过30天的唯一独立预测因素。