Prediction of the course of postoperative peritonitis
DOI:
https://doi.org/10.11603/2414-4533.2020.1.10732Keywords:
abdominal sepsis, postoperative peritonitis, prediction of a courseAbstract
The aim of the work: development of scale for predicting the risk of development of PP.
Materials and Methods. We analyzed 244 cases of postoperative peritonitis, operated in surgery department of Ivano-Frankivsk regional hospital in 2010–2019. Concomitant diseases were detected in 176 (72.1 %) patients. The male gender was slightly more prevalent – 138 (56.6 %). Patients' ages ranged from 18 to 88 years (median age 61 years). By the severity of the condition, the majority of patients (147 people (60.2 %)) – within 1–4 days after surgery (median – 2 days) were in intensive care unit. Peritonitis was local in 125 (51.2 %), diffuse – in 119 (48.8 %) patients. Postoperative complications developed in 74 cases (30.3 %) and were purulent in 75 %.
Results and Discussion. Based on the results of our studies, to indicate the severity of postoperative peritonitis as predictors we offer the following indicators: age of the patient over 60 years, the number of leukocytes in the peripheral blood above 12x109 g/l, the level of C-reactive protein in the serum above 10 mg/l, alkaline phosphatase activity of more than 1400 nmol/l-s, diene conjugate content of more than 2.5 units of optical density, malonic dialdehyde content of more than 5 nmol/ml, average molecular weight of more than 0.350 units. The value of CRP exceeding 5 mg/l is a bad prognostic sign, with 42 (30.9 %) of 136 patients with mild course of PP, and 98 (90.7 %) of 108 patients with severe one.
With positive four or more criteria there is a severe course of PP. Considering with results of researches, to determine the severity of postoperative peritonitis, we have proposed a working system for predicting the course of PP. Preliminary testing of this system confirmed its sensitivity 71.2 % and specificity 81.4 %.
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