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犬全层大肠切口术后短期结局及死亡和肠裂开潜在危险因素的评估

Evaluation of short-term outcomes and potential risk factors for death and intestinal dehiscence following full-thickness large intestinal incisions in dogs.

作者信息

Latimer Christian R, Lux Cassie N, Grimes Janet A, Benitez Marian E, Culp William T N, Ben-Aderet Daniel, Brown Dorothy C

出版信息

J Am Vet Med Assoc. 2019 Oct 15;255(8):915-925. doi: 10.2460/javma.255.8.915.

Abstract

OBJECTIVE

To determine complication rates for dogs in which full-thickness large intestinal incisions were performed, assess potential risk factors for death during hospitalization and for intestinal dehiscence following these surgeries, and report short-term mortality rates for these patients.

ANIMALS

90 dogs.

PROCEDURES

Medical records of 4 veterinary referral hospitals were reviewed to identify dogs that underwent large intestinal surgery requiring full-thickness incisions. Signalment, history, clinicopathologic data, medical treatments, surgical procedures, complications, and outcomes were recorded. Descriptive statistics were calculated; data were analyzed for association with survival to discharge (with logistic regression analysis) and postoperative intestinal dehiscence (with Fisher exact or Wilcoxon rank sum tests).

RESULTS

Overall 7-day postoperative intestinal dehiscence and mortality rates were 9 of 90 (10%) and 15 of 90 (17%). Dogs with preoperative anorexia, hypoglycemia, or neutrophils with toxic changes and those that received preoperative antimicrobial treatment had greater odds of death than did dogs without these findings. Preexisting colon trauma or dehiscence, preexisting peritonitis, administration of blood products, administration of > 2 classes of antimicrobials, positive microbial culture results for a surgical sample, and open abdominal management of peritonitis after surgery were associated with development of intestinal dehiscence. Five of 9 dogs with intestinal dehiscence died or were euthanized.

CONCLUSIONS AND CLINICAL RELEVANCE

Factors associated with failure to survive to discharge were considered suggestive of sepsis. Results suggested the dehiscence rate for full-thickness large intestinal incisions may not be as high as previously reported, but several factors may influence this outcome and larger, longer-term studies are needed to confirm these findings.

摘要

目的

确定接受大肠全层切口手术的犬只的并发症发生率,评估这些手术期间住院死亡及术后肠裂开的潜在风险因素,并报告这些患者的短期死亡率。

动物

90只犬。

方法

回顾4家兽医转诊医院的病历,以识别接受需要全层切口的大肠手术的犬只。记录信号、病史、临床病理数据、医疗治疗、手术过程、并发症及结果。计算描述性统计数据;分析数据与出院存活情况(采用逻辑回归分析)及术后肠裂开情况(采用Fisher精确检验或Wilcoxon秩和检验)的相关性。

结果

术后7天总体肠裂开率和死亡率分别为90只中的9只(10%)和90只中的15只(17%)。术前出现厌食、低血糖或有中毒性改变的中性粒细胞的犬只以及接受术前抗菌治疗的犬只比无这些表现的犬只死亡几率更高。既往存在结肠创伤或裂开、既往存在腹膜炎、输注血液制品、使用超过2类抗菌药物、手术样本微生物培养结果为阳性以及术后腹膜炎的开放腹腔处理与肠裂开的发生有关。9只发生肠裂开的犬中有5只死亡或实施了安乐死。

结论及临床意义

与未能存活至出院相关的因素提示存在败血症。结果表明大肠全层切口的裂开率可能不像先前报道的那么高,但有几个因素可能影响这一结果,需要开展更大规模、更长期的研究来证实这些发现。

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