腹部创伤后严重腹腔感染37例的诊治分析  

Diagnosis and treatment for 37 patients with severe intra-abdominal infection following abdominal injuries

作　　者：王建柏[1] 高劲谋[1] 胡平[1] 周伦上 赵山红[1] 梁绍勇[1] 刘朝普[1] 何平[1] 向江侠[1] 项震[1] 徐炎安[1] 

机构地区：[1]重庆市急救医疗中心创伤科 [2]解放军77126部队医院

出　　处：《创伤外科杂志》2014年第3期212-214,共3页Journal of Traumatic Surgery

摘　　要：目的：探讨腹部创伤后严重腹腔感染的原因及救治经验。方法回顾性分析我院2006年2月～2013年5月间收治的37例腹部创伤后严重腹腔感染的临床资料，男性31例，女性6例；年龄17～73岁，平均37．25岁。分析损伤部位、致伤原因、腹腔感染原因、治疗方法和并发症情况。结果本组37例病例经体格检查、腹腔穿刺、超声或CT等确诊。腹腔感染主要原因：剖腹探查漏诊13例，手术方式不当9例，胃肠延迟破裂7例。分别行胃肠修补或吻合7例，膈下引流8例次，脓肿穿刺置管引流5例次，结肠单腔造口4例，坏死肝组织清除和胆囊切除各1例，负压封闭引流2例。35例腹腔液作药物敏感鉴定，全部病例使用抗生素。并发脓毒性休克17例。死亡1例（2.7％），死于严重腹腔感染后多器官功能障碍综合征（ MODS），其余痊愈出院。结论漏诊胃肠道损伤、手术方式不当及胃肠延迟破裂是腹部创伤后严重腹腔感染的主要原因；外科手术控制感染源和早期合理使用抗生素是治疗严重腹腔感染的关键。Objective To investigate the cause and therapy of severe intra-abdominal infection following abdominal injuries .Methods The clinical data of 37 cases of severe abdominal infection following abdominal inju-ries in our hospital from Feb .2006 to May 2013 were studied retrospectively .There were 31 males and 6 females, with mean age of 37.25 years old （ranged from 17 to 73 years old）.The injury site,causes,abdominal infection causes,treatment methods and complications were analyzed .Results For all of the patients,the intra-abdominal infection was diagnosed by physical examination ,abdominal paracentesis ,ultrasound and CT scan .The causes of in-fection included miss-diagnosis in 13 cases during initial exploratory laparotomy ,inappropriate primary surgical treat-ment in 9 cases,delayed rupture after gastrointestinal contusion in 7 cases.Gastrointestinal repair or resection was performed in 7 cases,subphrenic drainage in 8 cases,percutaneous puncture and catheter drainage of intra-abdominal abscess in 5 cases,proximal colostomy and closure of distal end in 4 cases,debridement of necrosed hepatic tissue and cholecystotomy in 1 case,and vacuum sealing drainage in 2 cases.Bacteriological culture and examinations of abdominal fluid were performed and antibiotics was given in all the 35 cases.Seventeen cases were associated with septic shock and 1 case（2.7%）died of MODS due to severe intra-abdominal infection.The remaining cases were cured.Conclusion Miss-diagnosis of intestinal injury ,inappropriate primary surgical treatment and delayed rup-ture following gastrointestinal contusion are main causes of severe intra-abdominal infection in abdominal injuries . Operative control of infectious source and early rational use of antibiotics are the key elements to treat severe intra -abdominal infection .

关 键 词：创伤 腹腔感染 诊断 治疗 

分 类 号：R656[医药卫生—外科学]