目的:确定单剂量地塞米松对马小肠手术后反流(POR)风险的影响,并探讨其与切口并发症和短期生存的关系。
方法:为期11年(2008-2019年)的回顾性队列研究。
方法:位于英国的私人转诊中心。
方法:二百四十匹6个月大的客户拥有的马,进行剖腹探查以治疗小肠病变。
方法:97匹马接受了一次术中剂量的地塞米松(0.1mg/kg,IV).
结果:在接受地塞米松治疗的97匹马中,52例(53.6%)需要小肠切除。在143匹没有接受地塞米松的马中,78例(54.5%)进行了小肠切除术。共有70匹马(29%)发生了POR。接受地塞米松的马(25/97;26%)和未接受地塞米松的马(45/143;31%,P=0.34)。与POR发展相关的危险因素包括小肠切除术(比值比[OR]:4.55,95%置信区间[CI]:2.27-9.11,P<0.001),术后24小时PCV>40%(OR:4.11,95%CI:2-8.45,P<0.001),入院时白细胞计数>10×109/L(OR:3.29,95%CI:1.47-7.41,P=0.004)。地塞米松与POR的几率无关。再次剖腹手术的马具有较高的切口感染风险(OR:8.07,95%CI:1.98-32.81,P=0.004)。地塞米松给药与切口感染无关。POR的发展与短期生存率呈负相关(OR:0.07,95%CI:0.03-0.17,P≤0.001)。在生存的最终多变量模型中未保留地塞米松给药。
结论:在本研究人群中,术中地塞米松与POR的发生无关,对接受小肠疾病手术治疗的马的术后存活率或切口感染也没有影响。
OBJECTIVE: To determine the effect of a single intraoperative dose of dexamethasone on the risk of postoperative
reflux (POR) in horses undergoing small intestinal surgery and to investigate its association with incisional complications and short-term survival.
METHODS: Retrospective cohort study over an 11-year period (2008-2019).
METHODS: UK-based private referral center.
METHODS: Two hundred and forty client-owned horses >6 months of age undergoing exploratory laparotomy for treatment of a small intestinal lesion.
METHODS: Ninety-seven horses received a single intraoperative dose of dexamethasone (0.1 mg/kg, IV).
RESULTS: Of 97 horses that received dexamethasone, 52 (53.6%) required small intestinal resection. Of 143 horses that did not receive dexamethasone, small intestinal resection was performed in 78 (54.5%). A total of 70 horses (29%) developed POR. There was no difference in the risk of POR between horses that received dexamethasone (25/97; 26%) and those that did not (45/143; 31%, P = 0.34). Risk factors associated with the development of POR included small intestinal resection (odds ratio [OR]: 4.55, 95% confidence interval [CI]: 2.27-9.11, P < 0.001), a PCV >40% 24 hours postoperatively (OR: 4.11, 95% CI: 2-8.45, P < 0.001), and a WBC count >10 × 109/L on admission (OR: 3.29, 95% CI: 1.47-7.41, P = 0.004). Dexamethasone was not associated with the odds of POR. Horses undergoing repeat laparotomy had a higher risk of incisional infection (OR: 8.07, 95% CI: 1.98-32.81, P = 0.004). Dexamethasone administration was not associated with incisional infection. The development of POR was negatively associated with short-term survival (OR: 0.07, 95% CI: 0.03-0.17, P ≤ 0.001). Dexamethasone administration was not retained in the final multivariable model for survival.
CONCLUSIONS: Intraoperative dexamethasone was not associated with the development of POR in this study population, nor did it have an effect on postoperative survival or incisional infection in horses undergoing surgical management of small intestinal disease.