多重耐药菌所致腹腔感染的诊治策略  

Management strategy of intra-abdominal infection caused by multidrug-resistant bacteria

作　　者：刘海燕[1] 周郑[2] Liu Haiyan;Zhou Zheng(Department of Intensive Care Unit ,Anhui Provincial Hospital,The First Affiliated Hospital,University of Science and Technology of China,Hefei Anhui 230001,China;Department of Gastrointestinal Surgery ,Anhui Provincial Hospital,The First Affiliated Hospital,University of Science and Technology of China,Hefei Anhui 230001,China)

机构地区：[1]中国科学技术大学附属第一医院暨安徽省立医院重症医学科,合肥230001 [2]中国科学技术大学附属第一医院暨安徽省立医院胃肠外科,合肥230001

出　　处：《中华胃肠外科杂志》2018年第12期1351-1355,共5页Chinese Journal of Gastrointestinal Surgery

基　　金：安徽省高校优秀青年人才支持计划重点项目(gxyqZD2016051).

摘　　要：腹腔感染大多是创伤、手术和胃肠道疾病等因素引起的良性危重疾病,需要外科医师高度关注。病原菌耐药性增加是临床常见问题,多重耐药菌所致的腹腔感染更是临床医生面临的巨大挑战,主要见于医院获得性腹腔感染,其中又以革兰阴性菌最为常见。本文先根据文献总结多重耐药菌的常见类型、早期诊断和危险因素,后从抗感染药物治疗、感染源的控制、复苏与脏器支持以及营养支持治疗四个方面叙述多重耐药菌所致的腹腔感染的治疗策略。提出临床上应在了解多重耐药菌感染的危险因素、合理使用抗感染药物及有效的感染源控制措施的基础上,通过营养支持治疗促进胃肠道功能恢复,防止肠源性感染。同时,适当的脏器功能支持有助于提高多重耐药菌腹腔感染救治的成功率。Most of the intra-abdominal infections are benign and critical diseases caused by trauma, surgery and gastrointestinal diseases, which require the attention of surgeons. The increase of drug resistance of pathogens is a common clinical problem. The intra-abdominal infection caused by multidrug-resistant bacteria is a huge challenge faced by clinicians, and is mainly found in hospital-acquired abdominal infections, of which gram-negative bacteria are the most common. This paper firstly summarizes the common types, early diagnosis and risk factors of multidrug-resistant bacteria according to the literature, and then describes the treatment strategy of intra-abdominal infection caused by multidrug-resistant bacteria from four aspects: anti-infective medication, infection source control, resuscitation and organ support, and nutritional support treatment. In addition, we should promote gastrointestinal function recovery through nutritional support treatment and prevent intestinal source infection, on the basis of understanding the risk factors of multidrug-resistant infection, rational use of anti-infective medication and infection source control measures. At the same time, proper organ function support can help to improve the success rate in the treatment of multidrug-resistant intra-abdominal infection.

关 键 词：多重耐药菌 腹腔感染 感染源控制 抗感染药物 

分 类 号：R57[医药卫生—消化系统]