Modificaciones del intercambio gaseoso y del shunt pulmonar en un modelo experimental de hemorragia aguda

Objectives. To determine the predictive factors of mortality and morbidity in patients undergoing surgery for perforated gastroduodenal ulcer.
Patients and methods. A retrospective study was carried out of 131 consecutive patients treated surgically for perforated gastroduodenal ulcer. The parameters assessed were patient age and sex, the interval between initial onset and surgery, additional risk factors, surgical technique, leukocyte count, blood glucose level, urea, hemoglobin, duration of surgery, presence of pneumoperitoneum, intraoperative hypotension and degree of peritonitis.
Results. The rate of morbidity in this series was 20% and the mortality, 13%. The factor identified as significant predictors of morbidity and mortality were: age, sex, associated risk factors, an interval of more than 24 hours, preoperative blood glucose and urea levels, a leukocyte count of less than 10,000 cells, absence of pneumoperitoneum, intraoperative hypotension and the presence of purulent peritonitis. This system made it possible to identify 23 of the 27 patients who developed complications.
Conclusions.. In female patients over 70 years of age with associated medical diseases, an interval of more than 24 hours, blood glucose level over 150, urea level over 35, leukocyte count under 10,000, intraoperative hypotension and the presence of purulent peritonitis, the therapy of choice would probably be laparoscopic suture of the ulcer together with lavage and drainage of the abdominal cavity