Riverside University Health System Medical Center, Moreno Valley, CA 92555.
Riverside University Health System Medical Center, Moreno Valley, CA 92555.
J Surg Res. 2021 Aug;264:274-278. doi: 10.1016/j.jss.2021.03.003. Epub 2021 Apr 8.
Several trauma studies have shown that a "flat" inferior vena cava (IVC) is associated with poor clinical outcomes, including hypovolemic shock, major bleeding, transfusions and mortality. These studies utilize IVC measurements on computed tomography (CT) scans, and rarely include emergency general surgery patients. We examine the association between IVC flatness and clinical outcomes in a series of patients with perforated viscus.
Medical records at an academic hospital were reviewed of adults with perforated viscus. Patients who underwent laparotomy or laparoscopy were included if they underwent CT within 12 h prior to incision time. Perforated appendicitis was excluded. A ratio was calculated of the transverse to anterior-posterior diameter of the IVC at 3 locations, then averaged. Clinical outcomes were analyzed by the average IVC ratio.
A total of 83 patients were included. Using binomial regression, the average IVC ratio significantly correlated with ICU admission (OR 3.6, 95% CI 1.2 to 11) and acute kidney injury (OR 2.3, 95% CI 1.0 to 5.3), but not postoperative shock (OR 1.2, 95% CI 0.56 to 2.6).
A flat IVC on CT prior to an operation for perforated viscus was associated with worse outcomes, including increased rate of ICU admission and acute kidney injury. More outcomes research is needed to assess the potential role of IVC assessment in preoperative resuscitation.
几项创伤研究表明，下腔静脉（IVC）平坦与较差的临床结局相关，包括低血容量性休克、大出血、输血和死亡率。这些研究在 CT 扫描上测量 IVC，并很少包括急诊普通外科患者。我们在一系列穿孔性内脏患者中检查 IVC 平坦度与临床结局之间的关系。
回顾一家学术医院的医疗记录，纳入穿孔性内脏的成年人患者。如果在切口时间前 12 小时内进行 CT 检查且接受剖腹术或腹腔镜检查，则纳入患者。排除穿孔性阑尾炎。计算 IVC 在 3 个位置的横径与前后径的比值，然后取平均值。通过平均 IVC 比值分析临床结局。
共纳入 83 例患者。使用二项回归，平均 IVC 比值与 ICU 入院显著相关（OR 3.6，95%CI 1.2 至 11）和急性肾损伤（OR 2.3，95%CI 1.0 至 5.3），但与术后休克无关（OR 1.2，95%CI 0.56 至 2.6）。
在穿孔性内脏手术前 CT 上的 IVC 平坦与更差的结局相关，包括 ICU 入院率和急性肾损伤增加。需要更多的结局研究来评估 IVC 评估在术前复苏中的潜在作用。
