背景:这篇叙述性综述旨在评估辅助腹膜直接复苏(DPR)治疗成人损伤控制手术(DCS)伴和不伴失血性休克患者的疗效。及其对相关结果的影响。
方法:PubMed,谷歌学者,EMBASE,ProQuest,和Cochrane被搜索到4月13日发表的相关文章,2023年。包括评估成人DCS患者DPR利用的研究。结果包括腹部闭合时间,腹内并发症,住院死亡率,和ICU住院时间(ICULOS)。
结果:纳入5项评估437例患者的研究。失血性休克患者,DPR与腹部闭合时间减少相关(DPR4.1天,控制5.9天,p=0.002),腹腔内并发症,包括脓肿形成(DPR27%,控制47%,p=0.04),和ICULOS(DPR8天,控制11天,p=0.004)。无失血性休克患者的结果相互矛盾。在一项研究中,关闭时间减少(DPR5.9天,控制7.7天,p<0.02),在另一项研究中增加(DPR3.5天,控制2.5天,p=0.02),在一项研究中,腹内并发症减少(DPR27%,控制47%,p=0.04)和另一个类似,在一项研究中,ICULOS降低(DPR17天,控制24天,p<0.002),并在另一个时间内增加(DPR13天,控制11.4天,p=0.807)。
结论:在失血性休克患者中,辅助DPR与减少腹部闭合时间有关,腹腔内并发症,如脓肿,瘘管,出血,吻合口漏,ICULOS在没有失血性休克的患者中使用DPR显示出有希望但不一致的发现。
BACKGROUND: This narrative review aims to evaluate the efficacy of adjunct direct peritoneal resuscitation (DPR) in the treatment of adult damage control surgery (DCS) patients both with and without hemorrhagic shock, and its impact on associated outcomes.
METHODS: PubMed, Google Scholar, EMBASE, ProQuest, and Cochrane were searched for relevant articles published through April 13th, 2023. Studies assessing the utilization of DPR in adult DCS patients were included. Outcomes included time to abdominal closure, intra-abdominal complications, in-hospital mortality, and ICU length of stay (ICU LOS).
RESULTS: Five studies evaluating 437 patients were included. In patients with hemorrhagic shock, DPR was associated with reduced time to abdominal closure (DPR 4.1 days, control 5.9 days, p = 0.002), intra-abdominal complications including abscess formation (DPR 27 %, control 47 %, p = 0.04), and ICU LOS (DPR 8 days, control 11 days, p = 0.004). Findings in patients without hemorrhagic shock were conflicting. Closure times were decreased in one study (DPR 5.9 days, control 7.7 days, p < 0.02) and increased in another study (DPR 3.5 days, control 2.5 days, p = 0.02), intra-abdominal complications were decreased in one study (DPR 27 %, control 47 %, p = 0.04) and similar in another, and ICU LOS was decreased in one study (DPR 17 days, control 24 days, p < 0.002) and increased in another (DPR 13 days, control 11.4 days, p = 0.807).
CONCLUSIONS: In patients with hemorrhagic shock, adjunct DPR is associated with reduced time to abdominal closure, intra-abdominal complications such as abscesses, fistula, bleeding, anastomotic leak, and ICU LOS. Utilization of DPR in patients without hemorrhagic shock showed promising but inconsistent findings.