Mock C, Visser L, Denno D, Maier R
Holy Family Hospital, Berekum, Ghana.
Trop Doct. 1995 Jul;25(3):115-7. doi: 10.1177/004947559502500309.
One of the most severe complications of typhoid enteritis is perforation of ileal ulcerations. The typically high mortality rates from these perforations are in part due to extremely limited supportive care in hospitals in typhoid endemic areas. In the setting of a rural African hospital, this study demonstrated a decrease in overall mortality rate from 40% with one layer closure and chloramphenicol alone to 19% with two-layer closure and chloramphenicol, gentamicin and metronidazole. This was primarily due to a decrease in late (> 24 h) mortality. There was also a decrease in overall mortality rate from 43% with < 10 ml/kg of intraoperative fluid administration to 14% with > 10 ml/kg. This was primarily due to a decrease in early (< 24 h) mortality. Even within the constraints of the rural developing world, more aggressive initial fluid resuscitation can decrease early mortality, while broader spectrum antibiotics and two-layer closure can decrease late mortality from typhoid ileal perforation.
伤寒性肠炎最严重的并发症之一是回肠溃疡穿孔。这些穿孔导致的死亡率通常很高，部分原因是伤寒流行地区的医院支持治疗极其有限。在一家非洲农村医院的环境中，这项研究表明，单纯一层缝合加氯霉素治疗时总死亡率为40%，而两层缝合加氯霉素、庆大霉素和甲硝唑治疗时总死亡率降至19%。这主要是由于晚期（>24小时）死亡率降低。术中液体输注量<10 ml/kg时总死亡率为43%，而>10 ml/kg时总死亡率降至14%。这主要是由于早期（<24小时）死亡率降低。即使在农村发展中世界的限制条件下，更积极的初始液体复苏可以降低早期死亡率，而广谱抗生素和两层缝合可以降低伤寒性回肠穿孔的晚期死亡率。
