术后腹腔感染的挑战与治疗对策

Postoperative intra-abdominal infection (PIAI) is a severe clinical challenge, and the mortality rate of PIAI remains high globally. Early diagnosis and timely and effective treatment are crucial. Without timely and effective treatment, there will be a threat from high-risk factors that lead to treatment failure, such as drug-resistant bacteria infection, chronic critical illness, intra-abdominal hypertension, and multiple organ dysfunction. The rational application of antibacterial drugs, timely control of the source of infection, and supportive treatment including anti-sepsis, maintenance of organ function, and nutritional treatment are the keys to treatment. The control of the source of infection is fundamental to treatment; however, the existing measures for controlling the source of infection have not yet been standardized and unified. It is recommended to implement an incremental treatment strategy for the source of intra-abdominal infection, with minimally invasive establishment of active drainage as the first choice; surgical drainage when the source of infection cannot be controlled by active drainage; and the implementation of an open abdominal cavity therapy for PIAI patients with intra-abdominal hypertension.

术后腹腔感染(PIAI)是临床上严峻的挑战,全球PIAI的死亡率仍居高不下,早期诊断与及时有效治疗至关重要。如果没有及时有效的治疗,会面临导致治疗失败的高风险因素如耐药菌感染、慢性危重症、腹腔高压及多器官功能障碍等的威胁。合理的抗菌药物应用、及时的感染源控制以及包括对抗脓毒症、器官功能维护与营养治疗等在内的支持治疗是治疗的关键。感染源控制是治疗的根本,然而现有的感染源控制措施仍未得到规范统一。推荐实施腹腔感染源的递增式治疗策略,首选微创建立主动引流;对于主动引流未能控制感染源时行手术引流;对于合并有腹腔高压的PIAI病人实施腹腔开放疗法。