Jaffin J H, Ochsner M G, Cole F J, Rozycki G S, Kass M, Champion H R
Department of Trauma and Surgical Critical Care, Washington Hospital Center, Washington, DC 20010.
J Trauma. 1993 Jun;34(6):829-33. doi: 10.1097/00005373-199306000-00014.
Isolated injuries to hollow viscera may result in equivocal diagnostic peritoneal lavage (DPL) findings. Small bowel injuries cause alkaline phosphatase (AP) levels to increase in DPL effluent. The goal of this study was to better define the role of AP levels in the evaluation of the injured abdomen. We prospectively measured AP levels in 672 patients undergoing DPL. These were retrospectively compared with the clinical findings. All 12 patients with small bowel injuries and three of four with large bowel injuries had an AP level > 10 IU/L. There was one patient with an AP level > 10 IU/L without clinically significant intra-abdominal injury. An AP level > 10 IU/L in the DPL effluent predicted injury requiring laparotomy with a specificity of 99.8% and a sensitivity of 94.7%. We recommend using AP levels only in the management of patients with equivocal findings on DPL who would otherwise not undergo laparotomy. This selective use of AP levels will improve the probability of early diagnosis of bowel injury without increasing the cost of care.
中空脏器的孤立性损伤可能导致诊断性腹腔灌洗（DPL）结果不明确。小肠损伤会使DPL流出液中的碱性磷酸酶（AP）水平升高。本研究的目的是更好地确定AP水平在评估腹部损伤中的作用。我们前瞻性地测量了672例行DPL患者的AP水平。并将这些结果与临床发现进行回顾性比较。所有12例小肠损伤患者和4例大肠损伤患者中的3例，其AP水平>10 IU/L。有1例AP水平>10 IU/L的患者无具有临床意义的腹腔内损伤。DPL流出液中AP水平>10 IU/L预测需要剖腹手术的损伤，特异性为99.8%，敏感性为94.7%。我们建议仅在DPL结果不明确且否则不会接受剖腹手术的患者管理中使用AP水平。这种对AP水平的选择性使用将提高肠损伤早期诊断的概率，而不增加护理成本。
