损伤控制性外科在老年急性重症胆道感染患者中的临床应用

Application of damage control surgey in elderly patients with acute severe biliary tract infection

目的探讨损伤控制性外科(DCS)在老年急性重症胆道感染患者中的临床应用价值。方法回顾性分析2018年1月至2021年6月安徽医科大学附属宿州医院收治的70例老年急性重症胆道感染患者的临床资料,根据治疗方式分为损伤控制性治疗后手术治疗组(观察组,n=35)和急诊手术治疗组(对照组,n=35),比较分析两组患者在手术时间、术中出血量、术后腹腔引流管拔除时间、肠功能恢复时间、进食时间、住院时间,以及术后并发症的发生情况。结果观察组在手术时间[(147.57±53.01)min vs(203.42±34.16)min]、术中出血量([55.28±21.52)mL vs(195.14±51.54)mL]、术后引流管拔除时间[(6.55±3.68)d vs(8.25±3.51)d]、肠功能恢复时间[(28.25±9.50)h vs(39.85±12.25)h]、进食时间[(35.08±9.58)h vs(46.65±13.96)h]以及住院时间[(12.14±3.47)d vs(18.88±5.75)d]方面,均优于对照组(均P<0.05)。观察组术后肺部感染(14.28%vs 42.85%)、手术切口并发症(5.71%vs 34.28%)、电解质代谢紊乱(17.14%vs 40.00%)、低蛋白血症(17.14%vs 42.85%)的发生率以及患者病死率(0 vs 11.42%)方面,显著低于对照组(均P<0.05)。结论损伤控制性外科可有效降低老年急性重症胆道感染患者的手术风险,提高围手术期安全性,实现术后快速康复。

objective To explore the clinical value of damage control surgery(DCS)in elderly patients with acute severe biliary tract infection.Methods The clinical data of 70 elderly patients with acute severe biliary tract infection who were admitted to Suzhou Hospital Affiliated to Anhui Medical University from Jan.2018 to Jun.2021 were retrospectively analyzed.Patients were divided into the surgical treatment group after damage control treatment(observation group,n=35)and the emergency surgery group(control group,n=35),and the operation time,intraoperative blood loss,postoperative abdominal drain removal time,bowel function recovery time,eating time,hospitalization time,and the occurrence of postoperative complications between two groups were compared.Results In the observation group,the operation time[(147.57±53.01)min vs(203.42±34.16)min],intraoperative blood loss[(55.28±21.52)mL vs(195.14±51.54)mL],and postoperative drain removal time[(6.55±3.68)d vs(8.25±3.51)d],bowel function recovery time[(28.25±9.50)h vs(39.85±12.25)h],eating time[(35.08±9.58)h vs(46.65±13.96)h],hospital stay[(12.14±3.47)d vs(18.88±5.75)d]were better than the control group(all P<0.05).Besides,the rates of postoperative pulmonary infection(14.28%vs 42.85%),surgical incision complications(5.71%vs 34.28%),electrolyte metabolism disorder(17.14%vs 40.00%),the incidence of hypoalbuminemia(17.14%vs 42.85%)and mortality(0 vs 11.42%)in the observation group were significantly lower than those in the control group(all P<0.05).Conclusion Damage control surgery can effectively reduce the surgical risk,improve perioperative safety,and achieve rapid postoperative recovery in elderly patients with acute severe biliary tract infection.