Key result
Surgery within 6 hours for intestinal perforation linked to reduced water shift and respiratory support.
Why the study?
The optimal duration of the Golden Time for operation after traumatic intestinal perforations and the impact of colloid administration on postoperative fluid shifts were unclear.
Does surgery within 6 hours of injury and colloid administration improve postoperative fluid shifts in patients with traumatic intestinal perforation?
Cohort (n=38)
No
Does surgery within 6 hours of injury and colloid administration improve postoperative fluid shifts in patients with traumatic intestinal perforation?
The 'Golden Time' for surgery after traumatic intestinal perforation is approximately 6 hours to minimize postoperative fluid shifts and respiratory complications.
外傷性腸管破裂後のGolden Timeを術後水分移動の観点から検討すること,さらに膠質液投与が水分移動に与える影響を検討することを目的とした。術後水分移動を定量化する時間的な指標としては,手術から利尿期の開始までの時間(T2-T1)を,量的な指標としては,術前から利尿期までの期間血管内より血管外に移動したが利尿期にも血管内に戻らず血管外に貯留したと考えられる水分量をLost Water (LW)と名付け用いた。対象とした小腸破裂例26例を受傷から手術まで6時間未満の群と,6時間以上の群とに分けた場合のみ,両群間でT2-T1, LW/hの両指標ともに有意差が認められた。この両群間でPEEPを必要とした期間やFIO2の最高値にも有意差が認められた。以上より術後水分移動ならびに術後呼吸器合併症の頻度からみた,外傷性腸管破裂後のGolden Timeは受傷後約6時間であると考えられた。術後24時間以内に膠質液を投与された外傷性腸管破裂症例では,非投与例との間にT2-T1には有意差が認められなかったが,Lost Water/hは有意に減少した。外傷性腸管破裂症例における水分バランス,血清抗利尿ホルモン値(ADH),血色素量(Hb),血清浸透圧(Osm)
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Sawano et al. (1997) conducted a cohort in Traumatic small intestinal perforation (n=38). Surgical operation within 6 hours of injury vs. Surgical operation 6 hours or more after injury was evaluated on Postoperative water shift (time from operation to beginning of diuresis and lost water per hour) (p=<0.05). Surgical operation within 6 hours of injury for traumatic intestinal perforation significantly reduced postoperative water shift and the need for respiratory support compared to operations performed after 6 hours.
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