当前腹腔感染诊治的难题与对策  

Current problems and strategies in the management of intra-abdominal infection

作　　者：任建安 

机构地区：[1]南京军区南京总医院解放军普通外科研究所南京大学医学院临床学院,210002

出　　处：《中华胃肠外科杂志》2011年第7期483-486,共4页Chinese Journal of Gastrointestinal Surgery

基　　金：江苏省自然科学基金创新学者攀登项目（BK2010017）

摘　　要：腹腔感染的发病率逐年升高。腹腔感染处理的关键措施包括复苏、控制感染源和抗感染药物的使用。复苏要早期、及时并组合使用液体复苏与血管活性药物：控制感染源应在贯彻损伤控制的原则下．除传统的清创引流外．还包括B超或CT引导下的脓肿穿刺引流术和腹腔开放疗法：应合理使用抗感染药物，防止多重耐药菌和泛耐药菌的流行。通过肠康复措施促进肠道功能的恢复可防止肠道细菌易位．防止肠源性感染。监测与调控腹腔感染患者免疫功能的变化，可进一步提高腹腔感染的救治成功率。还应注意严重感染者可能存在的甲状腺功能低下现象并及时予以纠正。The incidence of intra-abdominal infection increases annually. The current management of intra-abdominal infection includes immediate resuscitation, prompt source control and appropriate usage of antibiotics. For patients with septic shock, fluid resuscitation should begin immediately when hypotension is present. Fluid resuscitation should be combined with vasoactive drugs. Damage control surgery promotes the development of ultrasound or CT guided percutaneous abscess drainage and open abdomen therapy. Rational use of anti-infective drugs could prevent prevalence of multiple antibiotics resistant bacteria and pan-resistant bacteria. The gut rehabilitation measures can improve the recovery of gut function and restore of enteral nutrition, and thus prevents bacterial transloeation in intra-abdominal infection patients. Monitoring and modulations of immune function may further improve the successful rate of treatment of intra-abdominal infections. Non-thyroidal illness syndrome may develop in the severe intra-abdominal infection patients and should be promptly corrected.

关 键 词：腹腔感染 复苏 抗生素 肠内营养 免疫功能 

分 类 号：R656[医药卫生—外科学]