非创伤性腹部急症中的损伤控制手术：序贯器官衰竭评估（SOFA）、急性生理与慢性健康状况评分系统II（APACHEII）及曼海姆腹膜炎指数的预后价值

Damage control surgery in non-traumatic abdominal emergencies: prognostic value of SOFA, APACHEII, and Mannheim peritonitis index.

作者信息

Rasslan Roberto, de Oliveira Ferreira Fábio, Parra Jeammy Andrea Perez, da Costa Ferreira Novo Fernando, Menegozzo Carlos Augusto Metidieri, Alves Pedro Henrique Ferreira, Bertolli Eduardo, Damous Sérgio Henrique Bastos, Rasslan Samir, Utiyama Edivaldo Massazo

机构信息

Departament of Surgery, Division of General Surgery and Trauma, Universidade de São Paulo, Av. Dr Enéas de Carvalho Aguiar, no. 255, 8th. Floor, São Paulo, Brazil.

出版信息

Updates Surg. 2025 Jan;77(1):255-262. doi: 10.1007/s13304-024-01984-3. Epub 2024 Sep 13.

DOI:10.1007/s13304-024-01984-3

PMID:39266908

Abstract

This study aimed to analyze the prognostic value of the SOFA, APACHE II, and MPI (Mannheim Peritonitis Index) scores in the indication for Damage Control Surgery (DCS) in non-trauma. Retrospective analysis of patients undergoing DCS between 2014 and 2019. SOFA and APACHE II scores were calculated using parameters preceding DCS, while MPI was based on surgical descriptions. Statistical analysis: Qualitative variables were compared using the Chi-square test or Fisher's exact test, and quantitative variables using Pearson's correlation coefficient. The Student's T test was employed for mean comparisons. The sample comprised 104 patients (59 males), with a median age of 63.5 years, of whom 52 (50%) were ASA IV. Operative findings leading to DCS included peritonitis (54; 51.9%), intestinal ischemia (39; 37.5%), inability to close the abdomen (8; 7.6%), and bleeding (3; 2.9%). The mortality rate was 75% (78/104). Thirty patients (28.8%) died after DCS; the remainder underwent one (35; 33.6%), two (21; 20.2%); three (8; 7.7%), and four or more (10;9.7%) revision procedures. The median lengths of ICU and hospital stays were 12.5 and 20.5 days, respectively. The median score values were as follows: SOFA: 12 (0-38), APACHE II: 25 (2-47), and MPI: 26 (8-43). Besides ASA classification (p = 0.03), mortality risk was influenced by: age (≤ 65 years vs. > 65 years; p = 0.04), SOFA (≤ 10 vs. > 10; p = 0.03), APACHE II (≤ 25 vs. > 25; p = 0.04), and MPI (≤ 25 vs. > 25; p = 0.003). The SOFA, APACHE II, and MPI scores proved to be valuable tools in the prognostic assessment of patients undergoing DCS in non-traumatic abdominal emergencies.

摘要

本研究旨在分析序贯器官衰竭评估（SOFA）、急性生理与慢性健康状况评分系统II（APACHE II）以及曼海姆腹膜炎指数（MPI）评分在非创伤性损伤控制手术（DCS）指征中的预后价值。对2014年至2019年间接受DCS的患者进行回顾性分析。SOFA和APACHE II评分使用DCS前的参数计算，而MPI基于手术描述。统计分析：定性变量采用卡方检验或Fisher精确检验进行比较，定量变量采用Pearson相关系数进行比较。采用学生t检验进行均值比较。样本包括104例患者（59例男性），中位年龄为63.5岁，其中52例（50%）为美国麻醉医师协会（ASA）IV级。导致DCS的手术发现包括腹膜炎（54例；51.9%）、肠缺血（39例；37.5%）、无法关腹（8例；7.6%）和出血（3例；2.9%）。死亡率为75%（78/104）。30例患者（28.8%）在DCS后死亡；其余患者接受了一次（35例；33.6%）、两次（21例；20.2%）、三次（8例；7.7%）以及四次或更多次（10例；9.7%）的翻修手术。重症监护病房（ICU）和住院时间的中位数分别为12.5天和20.5天。评分中位数如下：SOFA为12（0 - 38），APACHE II为25（2 - 47），MPI为26（8 - 43）。除ASA分级外（p = 0.03），死亡风险还受以下因素影响：年龄（≤65岁与>65岁；p = 0.04）、SOFA（≤10与>10；p = 0.03）、APACHE II（≤25与>25；p = 0.04）以及MPI（≤25与>25；p = 0.003）。SOFA、APACHE II和MPI评分被证明是评估非创伤性腹部急症接受DCS患者预后的有价值工具。