腹腔开放疗法在严重腹腔感染中的应用  

Open abdomen management for severe intraabdominal infection

作　　者：任建安[1] 

机构地区：[1]南京军区南京总医院全军普通外科研究所,210002

出　　处：《中华消化外科杂志》2014年第7期508-510,共3页Chinese Journal of Digestive Surgery

基　　金：国家自然科学基金面上项目（81270478）

摘　　要：严重腹腔感染传统的治疗措施包括感染源控制措施、抗感染药物合理应用.近年发展为液体复苏与脏器功能支持和腹腔开放疗法.综合这些措施可将腹腔感染的总体病死率降低至20％以下.腹部创伤与感染时,腹腔内压升高、腹腔灌注压降低、腹部脏器灌流不足,外科医师主动将腹腔敞开,此即为腹腔开放疗法.腹腔开放可有效降低腹内压,改善腹腔灌注压,有助于感染源的清创与引流,及时发现处理出血和肠瘘等并发症.腹腔开放疗法的主要并发症是肠空气瘘.防治肠空气瘘的主要措施包括各种临时关腹措施以及早期封闭裸露创面.The traditional management of severe intraabdominal infection include source control and antibiotics application.Fluid resuscitation and open abdomen management are recent development in the treatment of severe intraabdominal infection.The overall morbidity of severe intraabdominal infection was decreased under 20％ by these comprehensive treatment.Because of edema,inflammation and gastrointestinal dysfunction,the intraabdominal pressure was increased,the peritoneal infusion pressure was decreased and the perfusion was insufficient,and leaving abdomen open can reverse these condition,and is helpful for debridement and drainage of the source of infection,as well as management of bleeding and intestinal fistula.Entero-atmospheric fistula is the main severe complication after open abdomen,and it should be prevented by temporary abdominal closure and early closure of the wound.

关 键 词：腹腔感染 腹腔开放 肠瘘 腹腔间隙综合征 

分 类 号：R656[医药卫生—外科学]