东部战区总医院全军普通外科研究所,江苏 南京 210002
张锦鹏,硕士,主治医师,主要从事急重症外科方面的研究,Email:Jinpeng_Zhang@foxmail.com
任建安,Email:jiananr@nju.edu.cn
收稿:2024-11-12,
纸质出版:2024-12-22
移动端阅览
张锦鹏,吴秀文,邹江豪等.腹痛绿色通道对急腹症病人救治效率及预后影响的研究[J].腹部外科,2024,37(06):400-405.
Zhang Jinpeng,Wu Xiuwen,Zou Jianghao,et al.Impact of abdominal pain green channel on the treatment efficiency and prognosis of acute abdomen[J].J Abdominal Surg,2024,37(06):400-405.
张锦鹏,吴秀文,邹江豪等.腹痛绿色通道对急腹症病人救治效率及预后影响的研究[J].腹部外科,2024,37(06):400-405. DOI: 10.3969/j.issn.1003-5591.2024.06.002.
Zhang Jinpeng,Wu Xiuwen,Zou Jianghao,et al.Impact of abdominal pain green channel on the treatment efficiency and prognosis of acute abdomen[J].J Abdominal Surg,2024,37(06):400-405. DOI: 10.3969/j.issn.1003-5591.2024.06.002.
目的
2
探讨腹痛绿色通道对急腹症病人救治效率及预后的影响。
方法
2
回顾性收集2021年6月至2024年4月南京大学医学院附属金陵医院(东部战区总医院)全军普通外科研究所收治的513例急腹症病人,分为会诊模式组(
n
=197),腹痛绿色通道组(
n
=316例)。收集并比较两组基线数据、从入急诊到请会诊时间、入急诊到入院时间、入院到手术时间、住院时间、并发症和术后30 d病死率等。
结果
2
与腹痛绿色通道成立前相比,腹痛绿色通道成立后病人从急诊到手术的中位时间显著缩短(19.25 h比11.58 h,
P
<0.001),从入院到申请手术的中位时间缩短(0.83 h比0.74 h,
P
=0.047),整体住院时间显著减少(7.95 d比4.56 d,
P
<0.001),肺部感染(
P
=0.031)和腹腔感染(
P
=0.011)的发生率显著降低,严重并发症发生率降低(16.8%比5.1%,
P
<0.001)。腹痛绿色通道组夜间(18:00~次日8:00)手术比例显著增加(44.7%比67.1%,χ
2
=25.118,
P
<0.001)。高年资医生指导下的主治医生及主治医生级以下医生手术率增加(74.0%比89.9%,χ
2
=50.783,
P
<0.001)。
结论
2
腹痛绿色通道可以缩短急腹症病人术前等待时间,改善病人的总体治疗效果。
Objective
2
To explore the impact of abdominal pain green channel (Abdominal Fast-Track, AFT) on the efficiency of treatment and prognosis of patients with acute abdomen (AA).
Methods
2
From June 2021 to April 2024, the relevant clinical data were retrospectively reviewed for 513 hospitalized AA patients. They were assigned into two groups of consultation (
n
=197) and AFT (
n
=316). Baseline profiles, time from admission to emergency clinic for requesting consultation, time from admission to hospitalization, time from admission to surgery, length of hospitalization stay, complications and 30-day postoperative morbidity/mortality were compared between two groups.
Results
2
As compared with before establishing AFT, median time from emergency to surgery was significantly shorter after establishing AFT (19.25 vs 11.58 h,
P
<
0.001), median time from admission to re
questing surgery was shorter (0.83 vs 0.74 h,
P
=0.047) and overall length of hospital stay declined significantly (7.95 vs 4.56 day,
P
<
0.001), a significantly lower incidence of pulmonary (
P
=0.031) and abdominal (
P
=0.011) infections and a lower rate of severe complications (16.8% vs 5.1%,
P
<
0.001). The proportion of nighttime (18:00-8:00) surgeries was significantly higher in AFT group (44.7% vs 67.1%,
P
<
0.001). There was a higher rate of surgeries performed by attending physicians under the supervision of senior physicians and physicians below attending level (74.0% vs 89.9%,
P
<
0.001).
Conclusion
2
AFT may shorten preoperative waiting time and improve overall outcomes in AA patients.
Mayumi T , Yoshida M , Tazuma S , et al . The practice guidelines for primary care of acute abdomen 2015 [J]. Jpn J Radiol , 2016 , 34 ( 1 ): 80 - 115 . DOI: 10.1007/s11604-015-0489-z http://dx.doi.org/10.1007/s11604-015-0489-z .
Rogers SO , Kirton OC . Acute abdomen in the modern era [J]. N Engl J Med , 2024 , 391 ( 1 ): 60 - 67 . DOI: 10.1056/NEJMra2304821 http://dx.doi.org/10.1056/NEJMra2304821 .
Ibrahim NA , Oludara MA , Ajani A , et al . Non-trauma surgical emergencies in adults:Spectrum,challenges and outcome of care [J]. Ann Med Surg (Lond) , 2015 , 4 ( 4 ): 325 - 330 . DOI: 10.1016/j.amsu.2015.09.004 http://dx.doi.org/10.1016/j.amsu.2015.09.004 .
Grundmann R , Petersen M , Lippert H , et al . Das akute (chirurgische) Abdomen–Epidemiologie,Diagnostik und allgemeine Prinzipien des Managements [J]. Z Gastroenterol , 2010 , 48 ( 6 ): 696 - 706 . DOI: 10.1055/s-0029-1245303 http://dx.doi.org/10.1055/s-0029-1245303 .
Almeida Filho GF , Silva PPCE , Valverde Filho MT , et al . Acute abdomen in intensive care unit:etiology,comorbidity and severity of 1,523 patients [J]. Arq Bras Cir Dig , 2023 , 36 : e1778 . DOI: 10.1590/0102-672020230060e1778 http://dx.doi.org/10.1590/0102-672020230060e1778 .
Newton E , Mandavia S . Surgical complications of selected gastrointestinal emergencies:pitfalls in management of the acute abdomen [J]. Emerg Med Clin North Am , 2003 , 21 ( 4 ): 873 - 907 ,viii. DOI: 10.1016/s0733-8627(03)00087-7 http://dx.doi.org/10.1016/s0733-8627(03)00087-7 .
Li J , Xu R , Hu DM , et al . Prehospital delay and its associated psychosocial factors in patients presenting with acute appendicitis in a southwestern city in China:a single-centre prospective observational study [J]. BMJ Open , 2019 , 9 ( 6 ): e023491 . DOI: 10.1136/bmjopen-2018-023491 http://dx.doi.org/10.1136/bmjopen-2018-023491 .
Buck DL , Vester-Andersen M , Møller MH . Surgical delay is a critical determinant of survival in perforated peptic ulcer [J]. Br J Surg , 2013 , 100 ( 8 ): 1045 - 1049 . DOI: 10.1002/bjs.9175 http://dx.doi.org/10.1002/bjs.9175 .
Saunders DI , Murray D , Pichel AC , et al . Variations in mortality after emergency laparotomy:the first report of the UK Emergency Laparotomy Network [J]. Br J Anaesth , 2012 , 109 ( 3 ): 368 - 375 . DOI: 10.1093/bja/aes165 http://dx.doi.org/10.1093/bja/aes165 .
van der Wee MJL , van der Wilden G , Hoencamp R . Acute care surgery models worldwide:a systematic review [J]. World J Surg , 2020 , 44 ( 8 ): 2622 - 2637 . DOI: 10.1007/s00268-020-05536-9 http://dx.doi.org/10.1007/s00268-020-05536-9 .
Coccolini F , Sartelli M , Kluger Y , et al . The LIFE TRIAD of emergency general surgery [J]. World J Emerg Surg , 2022 , 17 ( 1 ): 41 . DOI: 10.1186/s13017-022-00447-7 http://dx.doi.org/10.1186/s13017-022-00447-7 .
To KB , Kamdar NS , Patil P , et al . Acute care surgery model and outcomes in emergency general surgery [J]. J Am Coll Surg , 2019 , 228 ( 1 ): 21 - 28.e7 . DOI: 10.1016/j.jamcollsurg.2018.07.664 http://dx.doi.org/10.1016/j.jamcollsurg.2018.07.664 .
Saunders DI , Murray D , Pichel AC , et al . Variations in mortality after emergency laparotomy:the first report of the UK Emergency Laparotomy Network [J]. Br J Anaesth , 2012 , 109 ( 3 ): 368 - 375 . DOI: 10.1093/bja/aes165 http://dx.doi.org/10.1093/bja/aes165 .
Aggarwal G , Huddart S , Quiney N , et al . Quality improvement in emergency general surgery [J]. J Am Coll Surg , 2022 , 234 ( 6 ): 1254 - 1255 . DOI: 10.1097/XCS.0000000000000159 http://dx.doi.org/10.1097/XCS.0000000000000159 .
Committee to Develop the Reorganized Specialty of Trauma , Surgical Critical Care , and Emergency Surgery . Acute care surgery:trauma,critical care,and emergency surgery [J]. J Trauma , 2005 , 58 ( 3 ): 614 - 616 . DOI: 10.1097/01.ta.0000159347.03278.e1 http://dx.doi.org/10.1097/01.ta.0000159347.03278.e1 .
Metzemaekers J , Bouwman L , de Vos M , et al . Clavien-Dindo,comprehensive complication index and classification of intraoperative adverse events:a uniform and holistic approach in adverse event registration for (deep) endometriosis surgery [J]. Hum Reprod Open , 2023 , 2023 ( 2 ): hoad019 . DOI: 10.1093/hropen/hoad019 http://dx.doi.org/10.1093/hropen/hoad019 .
Al Babtain I , Alraee SA , Shalhoub MM , et al . The impact of acute care surgery model on the management of acute appendicitis and cholecystitis:a single-center study [J]. Cureus , 2022 , 14 ( 7 ): e26724 . DOI: 10.7759/cureus.26724 http://dx.doi.org/10.7759/cureus.26724 .
Coccolini F , Kluger Y , Ansaloni L , et al . WSES worldwide emergency general surgery formation and evaluation project [J]. World J Emerg Surg , 2018 , 13 : 13 . DOI: 10.1186/s13017-018-0174-5 http://dx.doi.org/10.1186/s13017-018-0174-5 .
Poh BR , Cashin P , Dubrava Z , et al . Impact of an acute care surgery model on appendicectomy outcomes [J]. ANZ J Surg , 2013 , 83 ( 10 ): 735 - 738 . DOI: 10.1111/ans.12351 http://dx.doi.org/10.1111/ans.12351 .[PubMed]
Earley AS , Pryor JP , Kim PK , et al . An acute care surgery model improves outcomes in patients with appendicitis [J]. Ann Surg , 2006 , 244 ( 4 ): 498 - 504 . DOI: 10.1097/01.sla.0000237756.86181.50 http://dx.doi.org/10.1097/01.sla.0000237756.86181.50 .
Lau B , Difronzo LA . An acute care surgery model improves timeliness of care and reduces hospital stay for patients with acute cholecystitis [J]. Am Surg , 2011 , 77 ( 10 ): 1318 - 1321 .
Earley AS , Pryor JP , Kim PK , et al . An acute care surgery model improves outcomes in patients with appendicitis [J]. Ann Surg , 2006 , 244 ( 4 ): 498 - 504 . DOI: 10.1097/01.sla.0000237756.86181.50 http://dx.doi.org/10.1097/01.sla.0000237756.86181.50 .
Britt RC , Weireter LJ , Britt LD . Initial implementation of an acute care surgery model:implications for timeliness of care [J]. J Am Coll Surg , 2009 , 209 ( 4 ): 421 - 424 . DOI: 10.1016/j.jamcollsurg.2009.06.368 http://dx.doi.org/10.1016/j.jamcollsurg.2009.06.368 .
Cubas RF , Gómez NR , Rodriguez S , et al . Outcomes in the management of appendicitis and cholecystitis in the setting of a new acute care surgery service model:impact on timing and cost [J]. J Am Coll Surg , 2012 , 215 ( 5 ): 715 - 721 . DOI: 10.1016/j.jamcollsurg.2012.06.415 http://dx.doi.org/10.1016/j.jamcollsurg.2012.06.415 .
Qureshi A , Smith A , Wright F , et al . The impact of an acute care emergency surgical service on timely surgical decision-making and emergency department overcrowding [J]. J Am Coll Surg , 2011 , 213 ( 2 ): 284 - 293 . DOI: 10.1016/j.jamcollsurg.2011.04.020 http://dx.doi.org/10.1016/j.jamcollsurg.2011.04.020 .
Maa J , Carter JT , Gosnell JE , et al . The surgical hospitalist:a new model for emergency surgical care [J]. J Am Coll Surg , 2007 , 205 ( 5 ): 704 - 711 . DOI: 10.1016/j.jamcollsurg.2007.05.008 http://dx.doi.org/10.1016/j.jamcollsurg.2007.05.008 .
Sarmiento Altamirano D , Himmler A , Chango Sigüenza O , et al . The successful implementation of a trauma and acute care surgery model in Ecuador [J]. World J Surg , 2020 , 44 ( 6 ): 1736 - 1744 . DOI: 10.1007/s00268-020-05435-z http://dx.doi.org/10.1007/s00268-020-05435-z .
Buck DL , Vester-Andersen M , Møller MH . Surgical delay is a critical determinant of survival in perforated peptic ulcer [J]. Br J Surg , 2013 , 100 ( 8 ): 1045 - 1049 . DOI: 10.1002/bjs.9175 http://dx.doi.org/10.1002/bjs.9175 .
0
浏览量
2
下载量
0
CSCD
关联资源
相关文章
相关作者
相关机构
京公网安备11010802024621