腹腔感染源的递增式治疗策略

Step-up Approach of Source Control for Intra-abdominal Infection

腹腔感染(IAI)是临床经常遇到的棘手难题,合并脓毒症或者脏器功能障碍的这部分严重IAI患者的病死率仍高达30%~40%,如何提高严重IAI患者的治愈率仍然是临床所关注的问题。IAI早期准确的诊断、风险评估以及及时、有效的感染源控制是影响IAI患者预后的关键因素。感染源的控制是IAI治疗的根本,笔者推荐建立递增式感染源处理策略:首选微创改善引流或者建立主动引流途径;对于主动引流无法达到控制感染源的目的时应考虑开腹引流,在此过程需要遵守损伤控制原则;对于合并有腹腔高压的IAI患者应该积极地行腹腔开放疗法。

Intra-abdominal infection( IAI) is a clinical challenge,if combined with sepsis or multiple organ dysfunction,mortality rate of IAI will increase to 30% ~ 40%. How to improve the cure rate of patients with severe IAI is still a matter of clinical concern.Early diagnosis,risk assessment and appropriate treatment for IAI are key factors in determining the prognosis of IAI. The source control is considered fundamental of the treatment in most IAIs,and the step-up approach of source control is recommended. The first step is to set up the pathway of active drainage with minimally invasive; if the active drainage cannot achieve the purpose of controlling the source of infection,the second step with laparotomy should be executed,and in this process,the principle of damage control surgery should be considered; open abdomen surgery as third step should be implemented for IAIs accompanied with intra-abdominal hypertension.