To evaluate the development prevention and treatment of pneumonic injury after operation on aged patients with abdominal infection. We analyzed 77 aged patients (＞60 y) admitted from Jan. 1991 to Dec. 1992: 38 cases of which with abdominal infection (infection group), 39 cases without abdominal infection (non-infection group). All patients were given oxygen therapy and continuous SaO2 monitoring. Results: There were 28 patients with hypoxemia (SaO2＜95%) in infection group, with an occurrence rate of 73.7%. In non-infection group (12 patients), the rate of hyoxemia was 30.8%, which has significant difference between two groups (Ｐ＜0.001). All patients with hypoxemia were given oxygen therapy and 31 patients′ SaO2 was elevated. The efficient rate was 77.5%. Other 9 patients developed ARDS, the rate was 2.5% (9/40). In the infection group 8 patients developed ARDS with an occurrence rate of 21.1%. There was one patient with ARDS in the non-infection group, the rate was 2.6%. There was significant difference between two group (Ｐ＜0.05). Conclusions: The results suggest that hypoxemia is liable to occur in aged patients with abdominal infection after operation and these patients were liable to develop ARDS. Oxygen therapy and SaO2 monitoring is the important managements to these patients in prevention of pneumonic injury.
ObjectiveTo investigate the clinical significance of ultrasound-guided puncture and catheterization combined with choledochoscopy for debridement and drainage in treatment of patients with severe intra-abdominal infection (SIAI).MethodsThe clinical data of 7 patients with SIAI who underwent the debridement and drainage under ultrasound-guided puncture and catheterization combined with choledochoscopy from January 1, 2015 to December 31, 2017 in this hospital were retrospectively analyzed. The drainage sinus tracts were dilated for all patients. Then the choledochoscope was inserted into the infected areas along the dilated sinus tract. Finally, the drainage tube was placed under the guidance of the choledochoscope.ResultsOf the 7 patients, 6 patients were cured by this treatment, 1 case was converted to open surgery because the symptoms of illness were not improved. No relevant complications occurred. All patients were discharged after improvement of the disease. Currently, all cases were survival and no infection remained or recurred after follow-up to June 28, 2019.ConclusionsUltrasound-guided puncture and catheterization combined with choledochoscopy for debridement and drainage in treatment of SIAI is simple, safe, and effective. It could be used as an effective treatment for SIAI or alternative to open surgery.
Objective To investigate the main characteristics of intro-abdominal microbial infection and the risk factors for it after pancreaticoduodenectomy. Methods Clinical data of 200 patients underwent pancreaticoduodenectomy at the First Affiliated Hospital of Xinjiang Medical University from Sep. 2008 to Sep. 2013 were reviewed retrospectively to investigate the main characteristics of abdominal microbial infection after pancreaticoduodenectomy and risk factors for it. Results Of the 200 patients, cultures of drainage fluids were positive in 78 patients, and 42 of them(21.0%) met the diagnosis of intra-abdominal infection criterion. One hundred and eighty-five pathogenic strains were isolated totally, 64 strains of them(34.6%) were Gram positive cocci, 103 strains(55.7%) were Gram negative bacilli, and 18 strains (9.7%) were fungus. The top 5 kinds of bacteria in order were Staphylococcus aureus(31 strains), Pseudomonas aemginosa(28 strains), Escherichia co1i(22 strains), Klebsiella pneumoniae(18 strains), and Enterococcus faecium (14 strains). Most of the pathogens were resistant to broad-spectrum antibiotics. The resistance rate of Pseudomonas aeruginosa was 60.7%(17/28) to imipenem. Extended spectrum beta lactamases(ESBLs)-producing strains accounted for 22.7%(5/22) and 33.3%(6/18) in Escherichia coli and Klebsiella pneumoniae respectively. The detection rate of methicillin resistant staphylococcus aureus(MRSA) was 45.2%(14/31) in Staphylococcus aureus. Multivariate logistic regression analysis results showed that status of pancreatic fistula and pulmonary infection were the risk factors for intraabdominal infection, patients with high grade of pancreatic fistula(OR=16.252, P=0.003) and with pulmonary infection (OR=2.855, P=0.017) had higher incidence of intra-abdominal infection. Conclusion Gram negative bacilli is the main pathogenic bacteria of abdominal drainage fluids cultivation of microbiology after pancreaticoduodenectomy. Most of them have multi-drug resistance characteristic. Positive prevention and treatment of pancreatic fistula and pulmonary infection can reduce the incidence of intra-abdominal infection.
目的 探討腸外瘺并腹腔感染的診治。方法 回顧性分析我院2002年1月至2007年12月期間收治的86例腸外瘺并腹腔感染患者的臨床資料。結果 所有腸瘺多在術后1~2周發生，經口服或引流管注入60%泛影葡胺60～100 ml造影后明確診斷，均行腹腔引流液細菌培養，加強抗感染。20例患者行腹腔沖洗引流，62例在B型超聲定位下穿刺引流，4例急診行剖腹沖洗引流，其中2例行降結腸造瘺。2例合并糖尿病的患者因全身感染嚴重且反復發作，出現多器官功能衰竭，分別于術后第15 天和第28 天死亡。其余84例住院治療時間平均12 d，均順利出院。結論 對腸外瘺并腹腔感染的患者，早期徹底的腹腔沖洗及有效的腹腔和膿腫引流，是控制感染、治愈腸外瘺的關鍵。
【摘要】 目的 探討嚴重腹腔感染合并呼吸循環功能障礙的有效治療方法。方法 選擇2004 年10 月至2006 年5 月期間我院ICU 收治的嚴重腹腔感染合并呼吸循環功能障礙患者42 例,其中治療組( n = 22) 應用烏司他丁和生長激素聯合治療方案,對照組( n = 20) 應用常規治療。比較2 組病例的臨床病死率,并對2 組病例的ICU 住院時間及呼吸支持時間、循環支持時間的差異進行分析。結果 治療組與對照組的臨床病死率(22. 7 % vs35. 0 %) 差異無統計學意義( Pgt; 0. 05) ,而治療組較對照組ICU 住院時間〔(12. 1 ±4. 2) d vs (18. 8 ±3. 6) d〕、呼吸支持時間〔(10. 1 ±3. 1) d vs (15. 4 ±4. 4) d〕及循環支持時間〔(5. 6 ±1. 8) d vs (11. 3 ±2. 1) d〕明顯減少( P lt;0. 05) 。結論 烏司他丁和生長激素聯合使用可以改善嚴重腹腔感染合并呼吸循環功能障礙的治療效果。
Objective To summarize experience and efficacy of multidisciplinary treatment for severe intra-abdominal infection. Methods The clinical data of 17 patients with severe intra-abdominal infection underwent multidisciplinary treatment were analyzed retrospectively. There were 5 cases of severe acute pancreatitis, 4 cases of postoperative biliary fistula, 2 cases of intestinal fistula, 2 cases of pancreatic trauma, 1 case after resection for intestinal necrosis, 1 case of abdominal trauma, 1 case after operation for liver abscess, 1 case of unexplained severe intra-abdominal infection. The experiences of multidisciplinary treatment including the intensive care unit (ICU), surgery, blood purification center, and departments of pharmacy, nutrition, and digestion and internal medicine, and so on were summarized. Results After multidisciplinary treatment, 13 patients were cured, of which 4 patients treated by non-open operation. Three patients died, including 1 patient died of infectious shock, 1 patient died of pancreatic bed bleeding, 1 patient died of multiple organ failure. There was 1 case of automatic discharge. Conclusions Multidisciplinary treatment including ICU, surgery, blood purification center, and departments of pharmacy, nutrition, and digestion and internal medicine, and so on has an exact clinical curative effect in patients with severe intra-abdominal infection. Concept of damage control should be followed by surgical intervention. Abdominal cavity puncture and drainage has some advantages of small trauma and good clinical effect, which is suitable for infection control of patients with severe intra-abdominal infection, it could provide surgical condition and opportunity for patients required further surgical treatment.
ObjectiveTo understand the research progress of triggering receptor expressed on myeloid cells-1 (TREM-1) in abdominal infection and sepsis. MethodsThe relevant literatures at home and abroad in recent years regarding the research on the role of TREM-1 in abdominal infection and sepsis were retrieved and reviewed. ResultsRecent studies have focused on the key role of TREM-1 in abdominal infection and sepsis. TREM-1 is a pattern recognition receptor, which rapidly upregulated under inflammatory stimulation, forming a positive feedback loop that significantly amplifies the immune response. Its activation can trigger the cascaded release of a large number of proinflammatory factors and chemokines, exacerbating the inflammatory storm; at the same time, excessive activation of the pathway is regarded as the core driving mechanism for the progression of sepsis and even septic shock. ConclusionsThe TREM-1 mediated amplification effect of inflammatory cascades has been identified as a key link in immune imbalance in infectious diseases such as sepsis and abdominal infection. Further clarification of the expression dynamics of TREM-1 under different infectious conditions and the regulatory mechanisms of its signaling pathways is expected to provide new biomarkers for the clinical diagnosis and prognostic evaluation of infectious diseases, as well as theoretical basis for targeted intervention strategies and new drug development, thereby promoting the establishment and optimization of precise diagnosis and treatment regimens.
目的:探討莫西沙星注射液應用在中重度急性腹腔感染治療中的臨床療效與安全性。方法:共納入31 例患者,隨機分為羅氏芬加甲硝唑治療組(對照),羅氏芬2 g,每日1次,甲硝唑0.5 g,每日2次;莫西沙星治療組,莫西沙星400mg,每日1次,均為靜脈滴注,療程為7~14 天。結果:兩組的痊愈率分別為80 ％和81.25 ％,有效率分別為86.67 ％和87.5 ％,細菌清除率分別為91.67%與90%。組間比較差異均無統計學意義。兩組的不良反應發生分別為2／15和 1／16,主要表現為局部刺激及轉氨酶升高等。結論:莫西沙星注射液治療中重度腹腔細菌感染療效確切,安全性好。
ObjectiveTo review the advances of lymphocinesia in the abdominal cavity infection. MethodsDomestic and foreign literatures about the research of lymphocinesia in the abdominal cavity infection were collected and reviewed. ResultsBacterial translocation occurred when abdominal infection happened. At early phase, bacteria and endotoxin translocation could return and arrive the other tissues or organs through the lymphatic system. The peritoneal lymphatic stomata played an important role in lymphatic circulation, with strong absorption function and immune function. ConclusionsThe theory of lymphatic channels and lymphatic stomata immune pathway is a beneficial supplement to the theory that bacterial and endotoxin can spread to whole body through portal vein pathway, and combination of the 2 kinds of theories can explain the abdominal infection-related systematic infection better. Research of abdominal infection intervention which embarked on the lymphatic pathways would be a promising field.