论文部分内容阅读
目的腹腔感染是多发伤后常见并发症,临床诊治难度大,本文探讨其发生机制及诊治方法。方法回顾性分析我院2005年7月～2009年3月间收治多发伤中发生严重腹腔感染的42例患者,男性31例,女性11例;年龄18～71岁,平均38.46岁;道路交通伤29例,高处坠落伤9例,刀刺伤4例。38例伤后经当地医院紧急治疗,于伤后2～55天转至我院,其中18例有伤后剖腹探查手术史;另4例直接入我院。经体格检查、腹腔穿刺、腹部超声或CT等检查确诊。行腹腔脓肿穿刺置管引流5例次、腹腔脓肿剖腹手术引流15例次、肠管损伤外置或造口18例次、坏疽胆囊切除4例次、坏死肝组织清除5例次、腹部切口负压封闭引流12例次、腹部切口负压封闭辅助关闭4例次。结果在入院后24小时内确诊并确定性治疗18例,24～48小时内9例,2～7天内6例,8～21天内9例。腹腔感染及远隔部位的感染包括切口感染6例、大腿脓肿1例、腹膜后脓肿3例、腹腔内脓肿3例、肺部感染5例。腹部损伤相关的其他并发症发生8例次,包括肺梗塞1例、应激性溃疡2例、胸腔积液5例。除1例药物依赖者刀刺伤后2个月死亡,其余并发腹腔感染的伤者均痊愈出院。结论腹腔感染与漏诊肠道损伤、首次手术处理不当以及伤后就诊较晚等有关,应严密观察腹部临床表现,反复腹腔穿刺、CT检查等以明确诊断,积极手术处理腹腔感染灶、引流脓肿。对于脓毒症恶化持续加重的患者应多方寻求证据,必要时果断剖腹探查。
The purpose of abdominal infection is a common complication after multiple injuries, clinical diagnosis and treatment is difficult, this paper explores its mechanism and diagnosis and treatment methods. Methods A retrospective analysis of our hospital from July 2005 to March 2009 admitted to multiple injuries in 42 cases of severe abdominal infection, 31 males and 11 females; aged 18 to 71 years, mean 38.46 years old; road traffic injuries 29 cases, falling injury in 9 cases, stab wound in 4 cases. Thirty-eight cases were treated by the local hospital for emergency treatment and transferred to our hospital from 2 to 55 days after injury. Among them, 18 cases had history of laparotomy after injury and 4 cases were directly into our hospital. After physical examination, abdominal puncture, abdominal ultrasound or CT examination confirmed. Peritoneal abscess catheterization drainage 5 cases, abdominal abscess laparotomy drainage 15 cases, external or intestinal injury 18 cases of external fixation, gangrene gallbladder removal 4 cases, 5 cases of necrotic liver tissue removal, abdominal incision negative pressure Closed drainage in 12 cases, abdominal incision closure closed off 4 cases. Results Within 24 hours after admission, 18 cases were diagnosed and treated with definite measures, 9 cases in 24-48 hours, 6 cases in 2-7 days and 9 cases in 8-21 days. Infection in the abdominal cavity and distant sites included incisional wound infection in 6 cases, thigh abscess in 1 case, retroperitoneal abscess in 3 cases, intra-abdominal abscess in 3 cases and pulmonary infection in 5 cases. Other complications related to abdominal injury occurred in 8 cases, including 1 case of pulmonary infarction, 2 cases of stress ulcer and 5 cases of pleural effusion. In addition to a drug-dependent knife stab wounds after 2 months of death, the remaining patients with concurrent abdominal infection were cured and discharged. Conclusions Abdominal infection is related to missed diagnosis of intestinal tract injury, improper initial operation and later visit after injury. The abdomen should be closely observed with clinical manifestations of abdomen, repeated abdominal paracentesis and CT examination to confirm the diagnosis and treatment of abdominal infection and drainage. Patients with worsening sepsis should seek evidence from multiple sources and, if necessary, decipher the laparotomy.