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老年马和成熟非老年马小肠手术后与术后反流发展及短期生存相关的临床发现。

Clinical findings associated with development of postoperative reflux and short-term survival after small intestinal surgery in geriatric and mature nongeriatric horses.

作者信息

Boorman Sophie, Stefanovski Darko, Southwood Louise L

机构信息

Department of Clinical Studies, New Bolton Center, University of Pennsylvania, Kennett Square, Pennsylvania.

出版信息

Vet Surg. 2019 Jul;48(5):795-802. doi: 10.1111/vsu.13217. Epub 2019 Apr 19.

DOI:10.1111/vsu.13217
PMID:31002397
Abstract

OBJECTIVE

To determine risk factors, especially age, associated with postoperative reflux (POR; >2 L of reflux present upon intubation), high-volume POR (≥20 L in 24 hours), and short-term outcome after small intestinal (SI) surgery.

STUDY DESIGN

Retrospective case-control study.

SAMPLE POPULATION

Horses aged ≥16 years (geriatric; range, 16-30; n = 44) and <16 years (mature; range, 2-15; n = 39) with an SI surgical lesion that survived general anesthesia and did not have a second exploratory celiotomy during the same visit.

METHODS

Medical records (2009-2015) were reviewed; perioperative variables were evaluated for associations with outcomes by using multivariable logistic regression.

RESULTS

Postoperative reflux was associated with an increasing packed cell volume at admission (odds ratio [OR], 1.08; 95% CI, 1.00-1.16; P = .042) and presence of nasogastric reflux at admission (OR, 4.61; 95% CI, 1.3-15.69; P = .014). High-volume POR was associated with an increasing glycemia at admission (OR, 1.19; 95% CI, 1.01-1.40; P = .041), presence of nasogastric reflux at admission (OR, 10.05; 95% CI, 2.21-45.74; P = .003), and SI resection (OR, 10.52; 95% CI, 1.81-61.25; P = .009). Increasing surgical time (OR, 2.50; 95% CI, 1.16-5.29; P = .019) and high-volume POR (OR, 6.37; 95% CI, 2.12-19.12; P = .001) were associated with nonsurvival.

CONCLUSION

Age, considered as both a continuous variable and a categorical variable, was not associated with the development of POR, high-volume POR, or nonsurvival.

CLINICAL SIGNIFICANCE

Age does not influence the occurrence of POR and should not negatively impact an owner's decision to pursue surgery in aged horses.

摘要

目的

确定与术后反流(POR;插管时反流>2L)、大量POR(24小时内≥20L)以及小肠(SI)手术后短期预后相关的危险因素,尤其是年龄。

研究设计

回顾性病例对照研究。

样本群体

年龄≥16岁(老年;范围16 - 30岁;n = 44)和<16岁(成年;范围2 - 15岁;n = 39)的患有SI手术病变且在全身麻醉后存活且在同一就诊期间未进行二次剖腹探查的马匹。

方法

回顾医疗记录(2009 - 2015年);通过多变量逻辑回归评估围手术期变量与预后的相关性。

结果

术后反流与入院时血细胞比容升高(比值比[OR],1.08;95%置信区间,1.00 - 1.16;P = 0.042)以及入院时存在鼻胃反流(OR,4.61;95%置信区间,1.3 - 15.69;P = 0.014)相关。大量POR与入院时血糖升高(OR,1.19;95%置信区间,1.01 - 1.40;P = 0.041)、入院时存在鼻胃反流(OR,10.05;95%置信区间,2.21 - 45.74;P = 0.003)以及SI切除(OR,10.52;95%置信区间,1.81 - 61.25;P = 0.009)相关。手术时间延长(OR,2.50;95%置信区间,1.16 - 5.29;P = 0.019)和大量POR(OR,6.37;95%置信区间,2.12 - 19.12;P = 0.001)与非存活相关。

结论

年龄,无论是作为连续变量还是分类变量,均与POR、大量POR的发生或非存活无关。

临床意义

年龄不影响POR的发生,不应消极影响马主对老年马匹进行手术的决定。

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