Karki O B, Hazra N K, Timilsina B, Kunwar D
Department of Surgery, Manipal College of Medical Sciences, Phulbari-11, Pokhara, Nepal.
Department of Conservative Dentistry and Endodontics, Gandaki Medical College, Pokhara, Nepal.
Kathmandu Univ Med J (KUMJ). 2018;16(64):296-300.
Background Peritonitis due to hollow viscus perforation is one of common surgical emergency. Its accurate diagnosis and management is a challenge to every surgeon. This led to the development of disease severity grading systems that would aid in management and appropriately predict possible outcome. Objective Evaluation of Mannheim Peritonitis Index (MPI) score for predicting the morbidity and mortality in patients with peritonitis due to hollow viscus perforation. Method Prospective study of 126 patients operated for perforation peritonitis in Manipal College of Medical Sciences, Pokhara, Nepal from May 2015 to April 2018. Mannheim Peritonitis Index score was calculated for each patient. Data was analysed for predicting mortality and morbidity using SPSS 20. Pearson's Chisquare was used as a statistical test and considered as significant difference if p ≤ 0.05. Result Perforated appendix (35.7%), peptic ulcer perforation (31%) and truma (19%) were common causes of perforation peritonitis. Mean score was 18.55. The overall mortality and morbidity was 9% and 43% respectively with Mannheim Peritonitis Index scores of ≤ 20, 21-29, and ≥ 30 had a mortality of 0%, 14%, and 46% respectively. Presence of generalized peritonitis, organ failure at time of admission, type of intra peritoneal exudate carried more significance in predicting the mortality and morbidity in the post op period than other variables. Conclusion Mannheim Peritonitis Index is a simple and specific scoring system for predicting the mortality in patients with secondary peritonitis. Increasing scores are associated with poorer prognosis, needs intensive management.
背景 中空脏器穿孔所致腹膜炎是常见的外科急症之一。其准确诊断和处理对每位外科医生都是一项挑战。这促使了疾病严重程度分级系统的发展，该系统有助于处理并合理预测可能的结局。目的 评估曼海姆腹膜炎指数（MPI）评分对预测中空脏器穿孔所致腹膜炎患者的发病率和死亡率的价值。方法 对2015年5月至2018年4月在尼泊尔博克拉马尼帕尔医学院因穿孔性腹膜炎接受手术的126例患者进行前瞻性研究。计算每位患者的曼海姆腹膜炎指数评分。使用SPSS 20分析数据以预测死亡率和发病率。采用Pearson卡方检验作为统计检验，若p≤0.05则认为有显著差异。结果 穿孔性阑尾炎（35.7%）、消化性溃疡穿孔（31%）和创伤（19%）是穿孔性腹膜炎的常见病因。平均评分为18.55。曼海姆腹膜炎指数评分≤20、21 - 29和≥30时，总体死亡率分别为0%、14%和46%，总体发病率分别为9%和43%。与其他变量相比，弥漫性腹膜炎的存在、入院时的器官衰竭、腹腔内渗出液的类型在预测术后死亡率和发病率方面更具意义。结论 曼海姆腹膜炎指数是一种简单且特异的评分系统，用于预测继发性腹膜炎患者的死亡率。评分增加与预后较差相关，需要强化处理。
