以全身感染为主且伴有休克的急性重症阑尾炎的回顾性研究

A retrospective study about acute severe appendicitis combined with systemic infection and shock

目的探讨以全身感染为主且伴有休克的急性重症阑尾炎与非重症之间的差异以及可能形成的原因,为急性阑尾炎的临床治疗提供参考依据。方法收集新疆维吾尔自治区第三人民医院2017年1月至2019年8月收住的急性阑尾炎患者的病历资料及住院期间相关辅助检查,依据是否出现全身感染症状及休克进行分组,对比性别、年龄、病程、住院天数等基本信息、入院时以及术后2d的白细胞、中性粒细胞百分比、纤维蛋白原、C反应蛋白、降钙素原等辅助检查指标。结果共收集病历180份,根据病情程度可分为非重症阑尾炎组158例及重症阑尾炎组22例,两组间住院时间、入院降钙素原、C反应蛋白、总胆红素、间接胆红素及术后2d的中性粒细胞百分比、降钙素原、C反应蛋白存在差异(P <0.05)。结论以全身感染为主且伴有休克的急性重症阑尾炎患者有着病程短、腹腔感染轻、阑尾局部炎症重且多呈现坏疽的特点,与非重症阑尾炎患者无论在术前及术后炎性指标方面均有明显差异,降钙素原及早期发热可能提示为重症阑尾炎,重症阑尾炎应尽早选择手术治疗。

Objective To investigate the differences between acute severe appendicitis with systemic infection and shock and non-severe appendicitis, and to provide scientific basis for the diagnosis and treatment of acute appendicitis. Methods Data about acute appendicitis in Xinjiang occupational hospital from January 2017 to August 2019 were collected. Factors including gender, age, the use of antibiotics, disease course, diabetes, and blood indexes including white blood cells, neutrophil percentage,serum total bilirubin, indirect bilirubin, C-reactive protein, fibrinogen, procalcitonin(PCT)at admission and on the 2 th day after operation, were all analyzed and compared. Results A total of 180 patient records were collected. Then these patients were divided into non-severe group(158 cases)and severe group(22 cases)according to the severity of condition. The final analysis showed that hospital stays, serum total bilirubin,indirect bilirubin at admission and C-reactive protein, fibrinogen, procalcitonin(PCT)during perioperative had statistical difference(P<0.05). Conclusion Patients undergoing severe acute appendicitis combined with shock and systemic infection had short course of disease, light cavity infection, severe appendix local inflammationand gangrene, while preoperative and postoperative inflammatory indicators in non-severe appendicitis had obvious difference. procalcitonin and early fever may prompt severe appendicitis. so severe appendicitis should choose surgical treatment as soon as possible.