Lee, Gil Jae
(Department of Traumatology, Gachon University College of Medicine, Gachon University Gil Medical Center)
,
Lee, Min A
(Department of Traumatology, Gachon University College of Medicine, Gachon University Gil Medical Center)
,
Yoo, Byungchul
(Department of Traumatology, Gachon University College of Medicine, Gachon University Gil Medical Center)
,
Park, Youngeun
(Department of Traumatology, Gachon University College of Medicine, Gachon University Gil Medical Center)
,
Jang, Myung Jin
(Department of Traumatology, Gachon University College of Medicine, Gachon University Gil Medical Center)
,
Choi, Kang Kook
(Department of Traumatology, Gachon University College of Medicine, Gachon University Gil Medical Center)
Purpose: Immediate post-laparotomy hypotension (PLH) is a precipitous drop in blood pressure caused by a sudden release of abdominal tamponade after laparotomy in cases of severe hemoperitoneum. The effect of laparotomy on blood pressure in patients with significant hemoperitoneum is unknown. Method...
Purpose: Immediate post-laparotomy hypotension (PLH) is a precipitous drop in blood pressure caused by a sudden release of abdominal tamponade after laparotomy in cases of severe hemoperitoneum. The effect of laparotomy on blood pressure in patients with significant hemoperitoneum is unknown. Methods: In total, 163 patients underwent laparotomy for trauma from January 1, 2013 to December 31, 2015. Exclusion criteria included the following: negative laparotomy, only a hollow viscous injury, and hemoperitoneum <1,000 mL. After applying those criteria, 62 patients were enrolled in this retrospective review. PLH was defined as a decrease in the mean arterial pressure (MAP) ≥10 mmHg within 10 minutes after laparotomy. Results: The mean estimated hemoperitoneum was 3,516 mL. The incidence of PLH was 23% (14 of 62 patients). The MAP did not show significant differences before and after laparotomy (5 minutes post-laparotomy, 67.5±16.5 vs. 68.3±18.8 mmHg; p=0.7; 10 minutes post-laparotomy, 67.5±16.5 vs. 70.4±18.8 mmHg; p=0.193). The overall in-hospital mortality was 24% (15 of 62 patients). Mortality was not significantly higher in the PLH group (two of 14 [14.3%] vs. 13 of 48 [27.1%]; p=0.33). No statistically significant between-group differences were observed in the intensive care unit and hospital stay. Conclusions: PLH may be less frequent and less devastating than it is often considered. Surgical hemostasis during laparotomy is important. Laparotomy with adequate resuscitation may explain the equivalent outcomes in the two groups.
Purpose: Immediate post-laparotomy hypotension (PLH) is a precipitous drop in blood pressure caused by a sudden release of abdominal tamponade after laparotomy in cases of severe hemoperitoneum. The effect of laparotomy on blood pressure in patients with significant hemoperitoneum is unknown. Methods: In total, 163 patients underwent laparotomy for trauma from January 1, 2013 to December 31, 2015. Exclusion criteria included the following: negative laparotomy, only a hollow viscous injury, and hemoperitoneum <1,000 mL. After applying those criteria, 62 patients were enrolled in this retrospective review. PLH was defined as a decrease in the mean arterial pressure (MAP) ≥10 mmHg within 10 minutes after laparotomy. Results: The mean estimated hemoperitoneum was 3,516 mL. The incidence of PLH was 23% (14 of 62 patients). The MAP did not show significant differences before and after laparotomy (5 minutes post-laparotomy, 67.5±16.5 vs. 68.3±18.8 mmHg; p=0.7; 10 minutes post-laparotomy, 67.5±16.5 vs. 70.4±18.8 mmHg; p=0.193). The overall in-hospital mortality was 24% (15 of 62 patients). Mortality was not significantly higher in the PLH group (two of 14 [14.3%] vs. 13 of 48 [27.1%]; p=0.33). No statistically significant between-group differences were observed in the intensive care unit and hospital stay. Conclusions: PLH may be less frequent and less devastating than it is often considered. Surgical hemostasis during laparotomy is important. Laparotomy with adequate resuscitation may explain the equivalent outcomes in the two groups.
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문제 정의
However, the effect of laparotomy on blood pressure in patients with significant hemoperitoneum is unknown. This study aimed to elucidate the frequency of PLH and to determine the effect of laparotomy to blood pressure in cases of significant hemoperitoneum.
Depending on one’s point of view on PLH, there may be a conflict of opinion between the anesthesiologist and the surgeon, but little evidence exists regarding this issue. To the best of our knowledge, this is first study to explore the incidence of PLH.
제안 방법
The current study was designed to examine the incidence of PLH and the effect of laparotomy to patients with significant intra-abdominal bleeding. Depending on one’s point of view on PLH, there may be a conflict of opinion between the anesthesiologist and the surgeon, but little evidence exists regarding this issue.
대상 데이터
Patients with a negative laparotomy, hollow viscous injury, and hemoperitoneum <1,000 mL were excluded from this study because these conditions do not lead to any significant increase in intra-abdominal pressure. After applying the above criteria, 62 patients were ultimately enrolled in the current study. PLH was defined as a decrease in the mean arterial pressure (MAP) ≥10mmHg within 10 minutes after laparotomy.
데이터처리
Differences in nominal and categorical variables were compared using the Fisher’s exact test, while the Mann-Whitney U test was utilized to compare differences between continuous variables.
Differences in nominal and categorical variables were compared using the Fisher’s exact test, while the Mann-Whitney U test was utilized to compare differences between continuous variables. The MAP readings before and after laparotomy were compared using the paired t-test. Binary logistic regression was used in the multivariate analysis.
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