Su J M, Hsu H K, Chang H C, Hsu W H
Department of Surgery, Veterans General Hospital-Kaohsiung, Taipei, Taiwan, R.O.C.
Zhonghua Yi Xue Za Zhi (Taipei). 1994 Jul;54(1):20-5.
It is imperative that the surgeon promptly determine the severity of any acute injury of the upper gastrointestinal (UGI) tract by caustic material ingested and the definite therapy be instituted. Prognostic factors of such injuries have not been clearly demonstrated in previous reports. Here, some prognostic factors and recommended emergency surgical indications in clinical assessment are discussed.
Forty-six patients (22 men and 24 women; age range 19 to 77 years), sustaining acute corrosive injuries to the UGI tract, were retrospectively assessed from November 1990 to May 1993. Immediate management was given to prevent shock, to identify any associated injury and to observe patency of the airway. Emergency operation was performed if any signs of peritonitis, mediastinitis or sepsis were present. Age, sex, time interval between ingestion and initial resuscitation, consciousness, peritoneal sign, shock index, pH value and [HCO3-] in arterial blood gas were evaluated as prognostic factors with respect to mortality. Chi-square test with Yates' correction was used. A p value less than 0.05 was regarded as statistically significant.
Suicide attempt by caustic ingestion was in 40 patients (87%) and ingestion was accidental in 6 (13%). Acidic injury was specified in 36 patients (78.3%). In 14 severely injured patients, emergency exploratory laparotomy with or without esophagogastrectomy was performed in 9 (19.6%), of whom 2 survived. The other five patients were treated conservatively, and all died. Overall mortality rate was 26.1% (12/46). A significantly higher mortality rate was observed in patients with age > or = 50 years, positive peritoneal sign, shock index > 1, pH below 7.2 and bicarbonate concentration below 16 mEq/L as revealed by arterial blood gas (p < 0.05).
The prognostic factors related to a higher mortality rate included age 50 years old or more, positive peritoneal sign, shock index above 1, pH below 7.2 and [HCO3-] below 16 mEq/L in arterial blood gas. Recognition of these factors indicates further detailed study will be required to propose a caustic injury score for predicting severity. Nevertheless, emergency operation is recommended if there are positive signs of peritonitis or mediastinitis, shock index above 1, pH below 7.0 and [HCO3-] below 10 mEq/L in arterial blood gas.
外科医生必须迅速确定因摄入腐蚀性物质导致的上消化道（UGI）急性损伤的严重程度，并采取明确的治疗措施。以往的报告尚未明确证实此类损伤的预后因素。在此，讨论了临床评估中的一些预后因素及推荐的急诊手术指征。
回顾性评估了1990年11月至1993年5月期间46例上消化道遭受急性腐蚀性损伤的患者（男22例，女24例；年龄19至77岁）。立即进行处理以预防休克、识别任何合并伤并观察气道通畅情况。若出现腹膜炎、纵隔炎或脓毒症的任何体征，则进行急诊手术。将年龄、性别、摄入至初始复苏的时间间隔、意识、腹膜征、休克指数、动脉血气中的pH值和[HCO₃⁻]作为与死亡率相关的预后因素进行评估。采用校正Yates检验的卡方检验。p值小于0.05被视为具有统计学意义。
40例患者（87%）为吞服腐蚀性物质自杀，6例（13%）为意外摄入。36例患者（78.3%）为酸性损伤。14例重伤患者中，9例（19.6%）接受了急诊剖腹探查术，可伴或不伴食管胃切除术，其中2例存活。其他5例患者接受保守治疗，均死亡。总体死亡率为26.1%（12/46）。动脉血气显示，年龄≥50岁、腹膜征阳性、休克指数>1、pH<7.2及碳酸氢盐浓度<16 mEq/L的患者死亡率显著更高（p<0.05）。
与较高死亡率相关的预后因素包括年龄50岁及以上、腹膜征阳性、休克指数高于1、pH<7.2及动脉血气中[HCO₃⁻]<16 mEq/L。认识到这些因素表明需要进一步详细研究以提出用于预测严重程度的腐蚀性损伤评分。然而，若出现腹膜炎或纵隔炎的阳性体征、休克指数高于1、pH<7.0及动脉血气中[HCO₃⁻]<10 mEq/L，则建议进行急诊手术。
