目的 探讨腹腔双套管持续冲洗负压引流治疗腹腔严重感染的效果。方法 回顾性分析2012-09至2017-09武警广东总队医院收治的46例腹腔严重感染患者的临床资料。46例患者遵循损伤控制性外科(DCS)原则,在积极的液体复苏后急诊手术,以简便的手术方式控制感染源,清除腹腔内感染坏死组织,广泛冲洗腹腔,于肠破裂修补口或吻合口旁放置双套管行持续冲洗负压引流,术后在重症监护病房综合治疗。负压引流期间,观察双套管引流液的颜色、量及性状,动态检测血常规、C-反应蛋白及降钙素原,动态复查腹腔B超、CT。结果 46例中,死亡3例(6.5%),1例于24 h内因感染性休克并DIC死亡,另2例分别于术后2、5 d合并多脏器衰竭死亡;其余43例均治愈(93.5%),术后发生再次肠漏/吻合口漏2例,1例经双套管持续冲洗负压引流治愈,另1例经再次手术治愈,无因腹腔感染而再次手术者。结论 遵循DCS原则,应用双套管持续冲洗负压引流技术能提高腹腔严重感染患者的救治成功率,降低再次手术和病死率。

Objective To explore the effect of continuous irrigation/suction drainage by the double cannula in the treatment of severe intra-abdominal infections.Methods Retrospective analysis was conducted of the clinical data on 46 patients with severe intra-abdominal infections who had received treatment in Guangdong Provincial Crops Hospital of Chinese People’s Armed Police Force between September 2012 and September 2017. These patients followed the principle of Damage Control Surgery (DCS). After active fluid resuscitation, emergency surgery was performed to control the infection source with a simple surgical method. The intra-abdominal infection and necrotic tissue were cleared, the abdominal cavity extensively washed, continuous irrigation/suction drainage by the double cannula was placed beside the repaired intestinal rupture or anastomotic leakage, followed by postoperative comprehensive ICU treatment. During negative pressure drainage, the color, quantity and character of the double cannula drainage fluid were observed, the blood routine, C-reactive protein and procalcitonin were detected dynamically, and abdominal ultrasound or CT was dynamically performed.Results Among the 46 patients, 3 died (6.5%), one of whom died of septic shock and DIC within 24 hours, and the other two died due to multiple organ failure within 2 d and 5 d after operation. The rest of the cases were cured (93.5%), two of whom had intestinal/anastomotic leakage, one was cured by double cannula continuous irrigation/suction drainage, another one was cured after reoperation. None of these patients with intra-abdominal infection received a second surgery.Conclusions According to the principle of DCS, application of continuous irrigation/suction drainage by the double cannula in the treatment of severe intra-abdominal infection can increase the success rate of treatment, reduce reoperation and mortality.