腹壁巨大切口疝患者的术前评估及准备分析

目的：研究术前评估及准备分析对腹壁巨大切口疝患者术后的影响。方法回顾性分析2009年1月至2014年1月，喀什地区第一人民医院收治的36例腹壁巨大切口疝患者。对患者进行疝囊评估、腹腔扩容、呼吸功能准备和预防性抗生素等一系列巨大切口疝的术前评估及准备后实施手术。术后根据患者是否复发分为成功组与复发组。结果成功组患者在治疗后二氧化碳分压、氧气压和内源性呼吸末正压与复发组比较差异有统计学意义（t＝7．544、10．868、2．715，P＝0．000、0．000、0．010）。二组手术前成功组的电解质紊乱较复发组差异有统计学意义（χ2＝2．76，P＝0．036）。手术后呼吸机相关肺炎，多器官衰竭较复发组差异有统计学意义（χ2＝13．33、6．17，P＝0．001、0．012）。结论手术是治疗腹壁切口的唯一方法，完善的手术检查和准备至关重要。

Analysis of preoperative evaluation and preparation in giant abdominal incisional hernia

Objective To explore the effect of preoperative evaluation and preparation to patients with giant abdominal incisional hernia.Methods Retrospectively collecting 36 cases of giant incisional hernia who were admitted to Kashi People′s Hospital from January 2009 to January 201 4.The operations were performed after a series of preoperative evaluation and preparation including assessment of hernia sac, expansion of abdominal volume, adjustment of respiratory function and administration of prophylactic antibiotics.All patients were divided into two groups according to whether recurrence was occurred.Results There were significant differences in partial pressure of carbon dioxide,partial pressure of oxygen and intrinsic positive end expiratory pressure between successful group and recurrence group（t=7.544,10.868, 2.715,P =0.000,0.000,0.010）.Preoperative electrolyte disorder,postoperative ventilator associated pneumonia and multiple organ failure were different between the two groups（χ2 =2.76,1 3.33,6.1 7,P=0.036,0.001 ,0.012 ）.Conclusion Surgical treatment is the unique feasible way to treat abdominal incision hernia. However, careful perioperative assessment and meticulous preparation are extremely important.