腹部外科脓毒症368例的临床救治

Clinical treatment of 368 sepsis patients induced by severe surgical abdominal infection

目的探索降低腹部外科脓毒症患者病死率的综合治疗措施。方法整体治疗时,在“炎性介质、细菌、内外毒素、微循环、免疫功能、营养代谢、基础疾病、脏器功能”等方面进行兼顾和并治,相应实施14条具体治疗措施。提出了短程山莨菪碱联用地塞米松为主的综合救治方案；提出并应用“分阶段代谢营养支持”治疗,减少严重并发症的发生率；采用自制的“解毒固本汤”配合治疗,以改善免疫紊乱状态、调控炎性介质等。结果本组腹部外科脓毒症368例患者,总计死亡46例,死亡率为12．50%,死亡46例均为并发MODS的患者。结论腹部外科脓毒症治疗困难,死亡率高,采用综合救治新对策能降低腹部外科脓毒症的死亡率。

Objective To investigate and find a multiple treatment to reduce the mortality of sepsis patients induced by severe surgical abdominal infection. Methods While treating to severe surgical abdominal infection, inflammatory mediator bacteria, extoxin and endotoxin, immunity, dysfunction of microcireulation, nutrition and metabolism and the function of organs should be paid more attention on and considered as a whole. We also carried out 14 concrete treating measurement. Combined high dosage of anisodaminum and dexamethason were used in short-term. Bring forward nourishment support according to different stage of MODS and applying it in clinic could significantly reduce the companion syndrome. Oral administration of ＂JIE-DU-GU-BEN-TANG＂ which developed by our division could regulate the imbalance of immunity and inflammatory mediator. Results There were 46 patients died in 368 patients, mortality was 12.50%. Conclusion It was difficult to treat sepsis patients induced by severe abdominal infection and our new multiple treatment could significantly reduce the mortality of severe sepsis.