Grunau G, Heemken R, Hau T
Department of General Surgery, Nordwest-Krankenhaus Sanderbusch, Sande, Germany.
Eur J Surg. 1996 Aug;162(8):619-25.
To assess those factors which predict prognosis in patients with postoperative intra-abdominal infections.
Open study.
Teaching hospital, Germany.
48 patients who developed postoperative intra-abdominal infections between January 1989 and July 1993.
Calculation of APACHE II score and Mannheim Peritonitis Index (MPI). Evaluation of single components of APACHE II score.
Correlation between outcome and these variables together with time between first operation and reexploration, whether the source of infection was eliminated, whether the abdomen was managed by a closed or open technique, and the extent and origin of the infection.
Both APACHE II and MPI predicted outcome. Of the single components of the APACHE II score studied, those that correlated significantly with outcome were the Glasgow coma scale and chronic health evaluation (p < 0.001 in each case), and age (p < 0.01). The extent of peritonitis (local or diffuse) correlated with the APACHE II score and with outcome (p < 0.001 in each case). The time that elapsed before reoperation was significantly shorter in patients who died (8 days) than in those who survived (16 days, p = 0.03). In 37 of the patients the source of infection was eliminated resulting in 7 deaths (19%); all 11 of those in whom it was not eliminated died. Of the 35 patients who underwent closed treatment of the abdominal cavity 8 died (23%) compared with 10 of the 13 who underwent etappenlavage (77%, p < 0.01). Patients who underwent closed treatment, however, had fewer risk factors. No other variable correlated with outcome.
Outcome of patients with postoperative intra-abdominal infections correlates significantly with APACHE II and MPI, and in particular with age, Glasgow coma scale, and chronic health evaluation. It also correlates with time between the first and subsequent operations. Elimination of the source of infection and closed treatment of the abdominal cavity are associated with less risk factors and increased survival.
评估预测术后腹腔内感染患者预后的因素。
开放性研究。
德国教学医院。
1989年1月至1993年7月期间发生术后腹腔内感染的48例患者。
计算急性生理与慢性健康状况评分系统II（APACHE II）评分和曼海姆腹膜炎指数（MPI）。评估APACHE II评分的单个组成部分。
结局与这些变量之间的相关性，以及首次手术与再次探查之间的时间、感染源是否被清除、腹腔是采用闭合还是开放技术处理、感染的范围和起源。
APACHE II评分和MPI均能预测结局。在所研究的APACHE II评分的单个组成部分中，与结局显著相关的是格拉斯哥昏迷量表和慢性健康状况评估（每种情况p < 0.001）以及年龄（p < 0.01）。腹膜炎的范围（局部或弥漫性）与APACHE II评分及结局相关（每种情况p < 0.001）。死亡患者再次手术前经过的时间（8天）明显短于存活患者（16天，p = 0.03）。37例患者的感染源被清除，导致7例死亡（19%）；感染源未被清除的11例患者全部死亡。在接受腹腔闭合治疗的35例患者中，8例死亡（23%），而在接受分期冲洗的13例患者中有10例死亡（77%，p < 0.01）。然而，接受闭合治疗的患者危险因素较少。没有其他变量与结局相关。
术后腹腔内感染患者的结局与APACHE II评分和MPI显著相关，特别是与年龄、格拉斯哥昏迷量表和慢性健康状况评估相关。它还与首次手术和后续手术之间的时间相关。感染源的清除和腹腔的闭合治疗与较少的危险因素和更高的生存率相关。
