感染研究进展对外科临床实践的影响  

Advance of surgical infection research and its impact to the current surgical practice

作　　者：任建安[1] 

机构地区：[1]南京军区南京总医院(南京大学附属金陵医院)解放军普通外科研究所,江苏南京210002

出　　处：《中国实用外科杂志》2016年第2期129-132,共4页Chinese Journal of Practical Surgery

基　　金：全军十二五后勤科研计划重点项目(No.BNJ13J002);国家自然科学基金面上项目(No.81270478)

摘　　要：外科感染研究的进展促进了外科临床实践的不断进步。手术部位的感染是最可能被预防的医院获得性感染,有效的措施包括术前预防性抗生素使用、术中保温和及时拔除引流物。结直肠手术术前的肠道准备与口服抗生素可有效降低手术部位感染发生率。脓毒症的治疗包括早期复苏、器官功能支持和感染源控制措施。针对腹腔感染的感染源控制措施的进展包括经皮脓肿穿刺引流和腹腔开放疗法。坏死性筋膜炎是最严重的皮肤软组织感染,彻底清创和超广谱抗生素的及时使用是治疗成功的关键。持续与反复发作的感染可导致病人并发持续炎性反应与分解代谢综合征,其在临床上则表现为慢重症,感染源控制、及时的肠内营养支持与早期运动和功能锻炼可有效避免或逆转慢重症。Advances in surgical infection research improve the surgical clinical practice. Surgical site infection （SSI） is the most possible preventable hospital acquired infection. Preventive measures for the SSI include prophylactic antibiotics within two hours before operation, keeping warm during operation and remove of drains as early as possible. Adoption of oral antibiotics and bowel preparation before elective colectomy would reduce SSI. Resuscitation, organ function support and source controls are the most important measures in the management of surgical infection complicated with sepsis or septic shock. Percutaneous drainage of abscess and open abdomen therapy are the recent advances in the source control of intra-abdominal infection. Necrotic fasciitis is the most severe form of skin and soft tissue infections. Early radical debridement and appropriate antibiotics usage are the key points when managing the necrotic fasciitis. Persistent or recurrent infection is the leading cause of persistent inflammation and immnnosuppression catabolism syndrome which may manifest as chronic critical illness. Source control, early enteral nutrition and early rehabilitation are the effective ways to prevent or reverse chronic critical illness.

关 键 词：手术部位感染 脓毒症 腹腔感染 皮肤软组织感染 持续炎性反应与免疫抑制分解综合征 慢重症 

分 类 号：R6[医药卫生—外科学]