中国实用外科杂志

中国实用外科杂志

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新型冠状病毒肺炎疫情下严重腹腔感染紧急救治的外科选择及手术效果分析

陈志达，郗洪庆，梁文全，刘    怡，刘国晓，曹    博，崔    昊，卫    勃，陈    凛   

  1. 中国人民解放军总医院第一医学中心普通外科医学部腹部创伤外科，北京100853
  • 出版日期:2021-02-01 发布日期:2021-02-05

  • Online:2021-02-01 Published:2021-02-05

摘要： 目的    探究新型冠状病毒肺炎（COVID-19）疫情期间严重腹腔感染紧急救治的三级防护手术方式选择及手术效果分析。方法    回顾性分析解放军总医院第一医学中心普通外科医学部2020-01-25—2020-07-30急诊三级防护下完成的16例手术病例的完整临床资料，并将其设为防护组。同时对2019年同期同中心完成的急诊手术临床资料经倾向性评分匹配后选取16例设为对照组，与防护组进行匹配。对比分析防护组和对照组手术及术后恢复情况。结果    防护组术前准备时间、手术时间和总出血量3方面多于对照组（P均＜0.05），但两组在重症监护室（ICU）过渡时间、住院总时间、主动下床时间、镇痛药物使用时间、肠道排气时间、感染控制所需时间等术后恢复情况，以及切口感染、持续发热等近期并发症方面差异无统计学意义（P均＞0.05）；在术后感染性指标方面，术后第1天，防护组在白细胞计数、CRP、IL-6、PCT 4项指标高于对照组（P均＜0.05）。结论    三级防护手术是在COVID-19疫情特殊时期应对严重腹腔感染的有力救治措施，具有实践价值和临床意义。

关键词: 新型冠状病毒肺炎, 腹部感染, 创伤救治

Abstract: Surgical principle of delayed treatment for severe abdominal infection during corona virus disease 2019 outbreak and analysis of the surgery effect        CHEN Zhi-da, XI Hong-qing, LIANG Wen-quan, et al. Department of Abdominal Trauma, Medical Branch of General Surgery, First Medical Center of Chinese PLA General Hospital, Beijing 100853,China
Corresponding authors:CHEN Lin, E-mail: chenlinbj@sina.com；WEI Bo, E-mail: weibo@vip.163.com
CHEN Zhi-da and XI Hong-qing are the first authors who contributed equally to the article
Abstract    Objective    To explore the emergency treatment under three-level protection for severe abdominal infection during corona virus disease 2019 outbreak and analyze the surgery effect. Methods    The clinical data of 16 acute severe abdominal infection patients received surgery under three-level protection from January 25, 2020 to July 30, 2020 in Department of abdominal trauma, Medical Branch of General Surgery, First Medical Center of Chinese PLA General Hospital were analyzed retrospectively as protective group. At the same time, 16 patients were selected from127 acute operation patients from January 2019 to July 2019 as control group after propensity score matching. The surgery effect and postoperative recovery between protective group and control group were compared. Results    In protective group, the preoperative preparation time, operation time and the estimate blood loss were more than those of control group. But there was no significant difference in Intensive Care Unit stay，hospital stay，initiative ambulation，analgesic drugs time，first evacuation time，infection control time, as well as incision infection，persistent fever and other recent complications between the two groups (all P > 0.05) . WBC, CRP, IL6 and PCT on postoperative day 1 in protective group were s significantly higher than those of control group (all P＜0.05). Conclusion    Emergency surgery under three-level protection is an effective treatment measure response to severe abdominal infection in special period during corona virus disease 2019 outbreak, with vital practical value and clinical significance.

Key words: corona virus disease 2019, abdominal infection, trauma care