背景:结肠和胰腺损伤长期以来都与创伤患者的腹腔感染并发症独立相关。这项研究的目的是评估伴随胰腺损伤对创伤性结肠损伤患者预后的影响。
方法:确定连续3年接受结肠损伤手术治疗的患者。患者特征,损伤和休克的严重程度,胰腺损伤的存在和程度,记录术中充血红细胞(PRBC)输血情况。收集并比较结果,包括腹内脓肿形成和缝合线失败。然后进行多变量逻辑回归分析以确定伴随胰腺损伤对腹腔脓肿形成的影响。
结果:确定了243例创伤性结肠损伤患者。其中17人也有胰腺损伤。合并结肠和胰腺损伤的患者在年龄方面与孤立结肠损伤的患者在临床上相似,性别,穿透损伤机制,入院乳酸,ISS,缝合线故障,和入院收缩压。两种腹内脓肿率(88.2%vs29.6%,P<.001)和术中PRBC输血(8vs1个单位,P=.004)在胰腺和结肠联合损伤组中较高。多变量逻辑回归确定了两种术中PRBC输血(比值比,1.09;95%置信区间,1.04-1.15;P<.001)和伴随胰腺损伤(比值比,14.8;95%置信区间,3.92-96.87;P<.001)作为腹内脓肿形成的独立预测因子。
结论:术中PRBC输注和同时存在胰腺损伤是外伤性结肠损伤患者腹腔脓肿形成的独立预测因素。
BACKGROUND: Colon and pancreatic injuries have both long been independently associated with intraabdominal infectious complications in trauma patients. The goal of this study was to evaluate the impact of concomitant pancreatic injury on outcomes in patients with traumatic colon injuries.
METHODS: Consecutive patients over a 3-year period who underwent operative management of colon injuries were identified. Patient characteristics, severity of injury and shock, presence and grade of pancreatic injury, and intraoperative packed red blood cell (PRBC) transfusions were recorded. Outcomes including intraabdominal abscess formation and suture line failure were collected and compared. Multivariable logistic regression analysis was then performed to determine the impact of concomitant pancreatic injury on intraabdominal abscess formation.
RESULTS: 243 patients with traumatic colon injuries were identified. 17 of these also had pancreatic injuries. Patients with combined colon and pancreatic injuries were clinically similar to those with isolated colon injuries with respect to age, gender, penetrating mechanism of injury, admission lactate, ISS, suture line failure, and admission systolic blood pressure. Both intraabdominal abscess rates (88.2% vs 29.6%, P < .001) and intraoperative PRBC transfusions (8 vs 1 units, P = .004) were higher in the combined pancreatic and colon injury group. Multivariable logistic regression identified both intraoperative PRBC transfusions (odds ratio, 1.09; 95% confidence interval, 1.04-1.15; P < .001) and concomitant pancreatic injury (odds ratio, 14.8; 95% confidence interval, 3.92-96.87; P < .001) as independent predictors of intraabdominal abscess formation.
CONCLUSIONS: Both intraoperative PRBC transfusions and presence of concomitant pancreatic injury are independent predictors of intraabdominal abscess formation in patients with traumatic colon injuries.