背景:腹腔内感染(IAIs)是最常见的外科感染类型,与高相关的发病率和死亡率。近年来,由于使用抗生素,出现了各种耐药细菌,使腹部感染的治疗更具挑战性。早期手术探查可降低腹腔感染患者的死亡率和并发症的发生。然而,关于IAI手术最佳时机的现有证据仍然薄弱.在研究中,我们比较了手术时间对腹腔感染患者的影响,并试图确定手术的最佳时机。
目的:评估早期与延迟手术探查治疗IAI的疗效,就总死亡率而言。
方法:使用PubMed进行了系统的文献检索,EMBASE,Cochrane中央控制试验登记册,奥维德,和科学直接。采用系统评价的首选报告项目和Meta分析方法进行系统评价。根据外科手术的时机,我们将文献分为两组:早期手术和延迟手术。对于早期和延迟手术组,在初次手术干预12小时后进行干预,分别。主要结果指标是死亡率。文献检索于2021年5月5日至20日进行。我们还在2021年5月20日搜索了世界卫生组织国际临床试验注册平台搜索门户和ClinicalTrials.gov,以进行正在进行的试验。本研究已在国际前瞻性系统评价登记册上注册。
结果:我们确定了9个合格的试验比较。对IAIs患者进行早期手术探查(在12小时内进行)显着降低了患者的死亡率和并发症。提高了生存率,缩短了住院时间。
结论:与延迟手术相比,在12小时内早期手术探查可能对IAIs的治疗更有效。
BACKGROUND: Intra-abdominal infections (IAIs) is the most common type of surgical infection, with high associated morbidity and mortality rates. In recent years, due to the use of antibiotics, various drug-resistant bacteria have emerged, making the treatment of abdominal infections more challenging. Early surgical exploration can reduce the mortality of patients with abdominal infection and the occurrence of complications. However, available evidence regarding the optimal timing of IAI surgery is still weak. In study, we compared the effects of operation time on patients with abdominal cavity infection and tried to confirm the best timing of surgery.
OBJECTIVE: To assess the efficacy of early vs delayed surgical exploration in the treatment of IAI, in terms of overall mortality.
METHODS: A systematic literature search was performed using PubMed, EMBASE, Cochrane Central Register of Controlled Trials, Ovid, and ScienceDirect. The systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-analyses method. Based on the timing of the surgical operation, we divided the literature into two groups: Early surgery and delayed surgery. For the early and delayed surgery groups, the intervention was performed with and after 12 h of the initial surgical intervention, respectively. The main outcome measure was the mortality rate. The literature search was performed from May 5 to 20, 2021. We also searched the World Health Organization International Clinical Trials Registry Platform search portal and ClinicalTrials.gov on May 20, 2021, for ongoing trials. This study was registered with the International Prospective Register of Systematic Reviews.
RESULTS: We identified nine eligible trial comparisons. Early surgical exploration of patients with IAIs (performed within 12 h) has significantly reduced the mortality and complications of patients, improved the survival rate, and shortened the hospital stay.
CONCLUSIONS: Early surgical exploration within 12 h may be more effective for the treatment of IAIs relative to a delayed operation.