Division of Gastroenterological and General Surgery, Department of Surgery, School of Medicine, Showa University, Shinagawa, Tokyo, Japan.
Am Surg. 2023 Apr;89(4):907-913. doi: 10.1177/00031348211054702. Epub 2021 Nov 3.
It is unclear how effective recombinant thrombomodulin (rTM) treatment is in disseminated intravascular coagulation (DIC) during the perioperative period of gastrointestinal and hepato-biliary-pancreatic surgery. The current study aimed to evaluate the therapeutic outcomes of rTM for perioperative DIC.
We enrolled 100 consecutive patients diagnosed with perioperative DIC after gastrointestinal surgery, and hepato-biliary-pancreatic including emergency procedures, between January 2012 and May 2021. Patients received routine rTM treatment immediately after DIC diagnosis. Then, the DIC, Sequential Organ Failure Assessment (SOFA), and Acute Physiology and Chronic Health Evaluation (APACHE) II scores were calculated and used for evaluation. The outcomes of rTM treatment and the predictors of survival were evaluated.
The causative diseases of DIC were as follows: perforated peritonitis, n = 38; intestinal ischemia, n = 23; intra-abdominal abscess, n = 13; anastomotic leakage, n = 7; pneumonia, n = 7; cholangitis, n = 4; and others, n = 6. The 30-day mortality rate was 18.0%. There were significant differences in the platelet count (13.78 vs 10.41, P = .032) and the SOFA score (5.22 vs 9.89, P<.0001) at the start of DIC treatment between the survivor and non-survivor groups (day 0). The survivor group had a significantly lower DIC score (3.13 vs 4.93, P = .0006) and SOFA score (4.94 vs 12.14, P < .0001) and a higher platelet count (13.50 vs 4.34, P < .0001) than the non-survivor group on day 3.
Comprehensive and systemic treatment is fundamentally essential for DIC, in which rTM may play an important role in the treatment of perioperative DIC.
在胃肠和肝胆胰外科手术围手术期，重组血栓调节蛋白（rTM）治疗弥散性血管内凝血（DIC）的效果尚不清楚。本研究旨在评估 rTM 治疗围手术期 DIC 的疗效。
我们纳入了 2012 年 1 月至 2021 年 5 月期间因胃肠和肝胆胰手术（包括急诊手术）而被诊断为围手术期 DIC 的 100 例连续患者。患者在 DIC 诊断后立即接受常规 rTM 治疗。然后计算 DIC、序贯器官衰竭评估（SOFA）和急性生理学和慢性健康评估（APACHE）Ⅱ评分并用于评估。评估 rTM 治疗的结果和生存的预测因素。
DIC 的病因如下：穿孔性腹膜炎，n = 38；肠缺血，n = 23；腹腔脓肿，n = 13；吻合口漏，n = 7；肺炎，n = 7；胆管炎，n = 4；其他，n = 6。30 天死亡率为 18.0%。存活组和死亡组在 DIC 治疗开始时（第 0 天）血小板计数（13.78 vs 10.41，P =.032）和 SOFA 评分（5.22 vs 9.89，P<.0001）差异有统计学意义。存活组 DIC 评分（3.13 vs 4.93，P =.0006）和 SOFA 评分（4.94 vs 12.14，P <.0001）均显著低于死亡组，血小板计数（13.50 vs 4.34，P <.0001）显著高于死亡组。
综合和系统治疗是 DIC 的根本基础，rTM 在围手术期 DIC 的治疗中可能发挥重要作用。
