【摘要】 目的 探讨严重腹腔感染合并呼吸循环功能障碍的有效治疗方法。方法 选择2004 年10 月至2006 年5 月期间我院ICU 收治的严重腹腔感染合并呼吸循环功能障碍患者42 例,其中治疗组( n = 22) 应用乌司他丁和生长激素联合治疗方案,对照组( n = 20) 应用常规治疗。比较2 组病例的临床病死率,并对2 组病例的ICU 住院时间及呼吸支持时间、循环支持时间的差异进行分析。结果 治疗组与对照组的临床病死率(22. 7 % vs35. 0 %) 差异无统计学意义( Pgt; 0. 05) ,而治疗组较对照组ICU 住院时间〔(12. 1 ±4. 2) d vs (18. 8 ±3. 6) d〕、呼吸支持时间〔(10. 1 ±3. 1) d vs (15. 4 ±4. 4) d〕及循环支持时间〔(5. 6 ±1. 8) d vs (11. 3 ±2. 1) d〕明显减少( P lt;0. 05) 。结论 乌司他丁和生长激素联合使用可以改善严重腹腔感染合并呼吸循环功能障碍的治疗效果。
ObjectiveTo review the advances of lymphocinesia in the abdominal cavity infection. MethodsDomestic and foreign literatures about the research of lymphocinesia in the abdominal cavity infection were collected and reviewed. ResultsBacterial translocation occurred when abdominal infection happened. At early phase, bacteria and endotoxin translocation could return and arrive the other tissues or organs through the lymphatic system. The peritoneal lymphatic stomata played an important role in lymphatic circulation, with strong absorption function and immune function. ConclusionsThe theory of lymphatic channels and lymphatic stomata immune pathway is a beneficial supplement to the theory that bacterial and endotoxin can spread to whole body through portal vein pathway, and combination of the 2 kinds of theories can explain the abdominal infection-related systematic infection better. Research of abdominal infection intervention which embarked on the lymphatic pathways would be a promising field.
ObjectiveTo evaluate the safety and efficacy of unconventional abdominal drainage after laparoscopic hepatectomy.MethodsThe clinicopathologic data of patients who underwent laparoscopic hepatectomy for liver tumors in the Mianyang Central Hospital from June to December 2019 and met the inclusion criteria were retrospectively collected. Based on whether drainage tube was placed in the abdominal cavity during operation, the patients were divided into non-catheterized group (without drainage tube) and catheterized group (with drainage tube). The intraoperative data and postoperative complications (e.g. intraabdominal hemorrhage, bile leakage, abdominal infection, and liver failure) were compared between the two groups. Then, the intraoperative data and postoperative conditions of liver cancer and non-liver cancer patients with or without abdominal drainage tube were compared and analyzed.ResultsA total of 117 eligible patients were included in the study. The non-catheterized group had 59 patients and the catheterized group had 58 patients. The patients with liver cancer had 84 patients (44 non-catheterized patients and 40 catheterized patients) and the patients without liver cancer had 33 patients (15 non-catheterized patients and 18 catheterized patients). ① On the whole, the groups were comparable in the baseline data between the non-catheterized group and the catheterized group, such as gender, age, HBV infection, body mass index, hepatic function index, liver stiffness value, disease category, etc. (P>0.05). Compared with the catheterized group, the non-catheterized group had earlier off-bed activities and earlier flatus time (P<0.001), and shorter postoperative hospital stay (P=0.030). However, no statistically significant differences were found in other indicators between the two groups (P>0.05). ② Whether the patients had liver cancer or not, the non-catheterized patients still had earlier off-bed activities and earlier flatus time as compared with the catheterized patients (P<0.001). Among the patients with liver cancer, no difference was found in postoperative hospital stay. However, among the patients without liver cancer, the non-catheterized patients had shorter postoperative hospital stay than the catheterized patients (P=0.042). No statistically significant differences were found in other indicators between the catheterized patients and non-catheterized patients (P>0.05).ConclusionFor technologically skilled laparoscopic hepatectomy center, selectively not placing peritoneal drainage tube after surgery might better promote the health of patients.
Objective To summarize experience and efficacy of multidisciplinary treatment for severe intra-abdominal infection. Methods The clinical data of 17 patients with severe intra-abdominal infection underwent multidisciplinary treatment were analyzed retrospectively. There were 5 cases of severe acute pancreatitis, 4 cases of postoperative biliary fistula, 2 cases of intestinal fistula, 2 cases of pancreatic trauma, 1 case after resection for intestinal necrosis, 1 case of abdominal trauma, 1 case after operation for liver abscess, 1 case of unexplained severe intra-abdominal infection. The experiences of multidisciplinary treatment including the intensive care unit (ICU), surgery, blood purification center, and departments of pharmacy, nutrition, and digestion and internal medicine, and so on were summarized. Results After multidisciplinary treatment, 13 patients were cured, of which 4 patients treated by non-open operation. Three patients died, including 1 patient died of infectious shock, 1 patient died of pancreatic bed bleeding, 1 patient died of multiple organ failure. There was 1 case of automatic discharge. Conclusions Multidisciplinary treatment including ICU, surgery, blood purification center, and departments of pharmacy, nutrition, and digestion and internal medicine, and so on has an exact clinical curative effect in patients with severe intra-abdominal infection. Concept of damage control should be followed by surgical intervention. Abdominal cavity puncture and drainage has some advantages of small trauma and good clinical effect, which is suitable for infection control of patients with severe intra-abdominal infection, it could provide surgical condition and opportunity for patients required further surgical treatment.
目的:探讨莫西沙星注射液应用在中重度急性腹腔感染治疗中的临床疗效与安全性。方法:共纳入31 例患者,随机分为罗氏芬加甲硝唑治疗组(对照),罗氏芬2 g,每日1次,甲硝唑0.5 g,每日2次;莫西沙星治疗组,莫西沙星400mg,每日1次,均为静脉滴注,疗程为7~14 天。结果:两组的痊愈率分别为80 ％和81.25 ％,有效率分别为86.67 ％和87.5 ％,细菌清除率分别为91.67%与90%。组间比较差异均无统计学意义。两组的不良反应发生分别为2／15和 1／16,主要表现为局部刺激及转氨酶升高等。结论:莫西沙星注射液治疗中重度腹腔细菌感染疗效确切,安全性好。
ObjectiveTo explore the clinical efficacy and application significance of continuous irrigation and drainage for intestinal fistula combined with abdominal infection.MethodsClinical data of 62 patients with intestinafistula combined with abdominal infection admitted by Department of General Surgery of The 940th Hospital of The People’s Liberation Army Joint Service Support Force from March 2012 to March 2017 were retrospectively analyzed. All patients were treated with continuous abdominal flushing and drainage after emergency surgery. The duration of peritoneal flushing, antibiotic use, blood picture recovery, fistula healing, and total hospitalization were summarized.ResultsAll 62 patients were treated successfully without death or septic shock. Among them, 49 cases of intestinal fistula were treated with continuous abdominal flushing and drainage, and 13 cases of intestinal fistula were treated by continuous flushing and drainage of the abdominal cavity. There were 6 cases of abdominal abscess, 5 cases of incision infection, 5 cases of pleural effusion, and 2 cases of pulmonary infection after surgery. The continuous abdominal cavity washing time was (45±21) d, antibiotic use time was (14±7) d, blood image recovery time was (16±8) d, the healing time of fistula was (47±24) d, total length of hospital stay was (56±27) d.ConclusionsFor intestinal fistula combined with abdominal cavity infection, peritoneal continuous flushing and drainage is related with curative effect, high cure rate, fewer complications, simple washing equipment, simple technology, lower cost, and convenient nursing, which can create a good condition for the complexity or refractory patients with intestinal fistula, and has a high clinical application significance.
Objective To investigate the main characteristics of intro-abdominal microbial infection and the risk factors for it after pancreaticoduodenectomy. Methods Clinical data of 200 patients underwent pancreaticoduodenectomy at the First Affiliated Hospital of Xinjiang Medical University from Sep. 2008 to Sep. 2013 were reviewed retrospectively to investigate the main characteristics of abdominal microbial infection after pancreaticoduodenectomy and risk factors for it. Results Of the 200 patients, cultures of drainage fluids were positive in 78 patients, and 42 of them(21.0%) met the diagnosis of intra-abdominal infection criterion. One hundred and eighty-five pathogenic strains were isolated totally, 64 strains of them(34.6%) were Gram positive cocci, 103 strains(55.7%) were Gram negative bacilli, and 18 strains (9.7%) were fungus. The top 5 kinds of bacteria in order were Staphylococcus aureus(31 strains), Pseudomonas aemginosa(28 strains), Escherichia co1i(22 strains), Klebsiella pneumoniae(18 strains), and Enterococcus faecium (14 strains). Most of the pathogens were resistant to broad-spectrum antibiotics. The resistance rate of Pseudomonas aeruginosa was 60.7%(17/28) to imipenem. Extended spectrum beta lactamases(ESBLs)-producing strains accounted for 22.7%(5/22) and 33.3%(6/18) in Escherichia coli and Klebsiella pneumoniae respectively. The detection rate of methicillin resistant staphylococcus aureus(MRSA) was 45.2%(14/31) in Staphylococcus aureus. Multivariate logistic regression analysis results showed that status of pancreatic fistula and pulmonary infection were the risk factors for intraabdominal infection, patients with high grade of pancreatic fistula(OR=16.252, P=0.003) and with pulmonary infection (OR=2.855, P=0.017) had higher incidence of intra-abdominal infection. Conclusion Gram negative bacilli is the main pathogenic bacteria of abdominal drainage fluids cultivation of microbiology after pancreaticoduodenectomy. Most of them have multi-drug resistance characteristic. Positive prevention and treatment of pancreatic fistula and pulmonary infection can reduce the incidence of intra-abdominal infection.
To observe the change in plasma endotoxin and cytokine during the early period of intra-abdominal infection (IAI) complicated by multiple system organ dysfunction (MSOD) in animals. Twenty rabbits were randomly divided in to two groups. One group received the operation of cecal ligation plus puncture (CLP) inducing IAI complicated by MSOD, and another group received sham operation as a control. All animals were placed in metabolic cages and maintained with intravenous infusion for one week. Plasma levels of endotoxin and cytokine (TNF, IL-1, IL-6) were determined seperately at the beginning (0 hour) or 1, 2, 3, 4, 5, 6 and 24 hours after CLP. Blood bacteria cultures and pathological examination of several organs were made when the animal was dead or killed. Results: The levels of plasma endotoxin, TNF and IL-6 were found to be significantly increased at one or two hours after CLP, the incidence rate of bacteriemia was 80% and the pathological alterations in the abdomen and organs were remarkale, with an average survival time of 84.1±39.0 hours in CLP group. No change in plasma IL-1 level was found in the CLP group. Conclusion: The plasma levels of endotoxin and cytokine (TNF and IL-6) do increase in the early period of IAI complicated by MSOD, and the change in plasma IL-1 is not obvious.
目的 探讨肠外瘘并腹腔感染的诊治。方法 回顾性分析我院2002年1月至2007年12月期间收治的86例肠外瘘并腹腔感染患者的临床资料。结果 所有肠瘘多在术后1~2周发生，经口服或引流管注入60%泛影葡胺60～100 ml造影后明确诊断，均行腹腔引流液细菌培养，加强抗感染。20例患者行腹腔冲洗引流，62例在B型超声定位下穿刺引流，4例急诊行剖腹冲洗引流，其中2例行降结肠造瘘。2例合并糖尿病的患者因全身感染严重且反复发作，出现多器官功能衰竭，分别于术后第15 天和第28 天死亡。其余84例住院治疗时间平均12 d，均顺利出院。结论 对肠外瘘并腹腔感染的患者，早期彻底的腹腔冲洗及有效的腹腔和脓肿引流，是控制感染、治愈肠外瘘的关键。