Therapy of peritonitis today. Surgical management and adjuvant therapy strategies
Therapy of peritonitis today. Surgical management and adjuvant therapy strategies
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今天治疗腹膜炎。
DOI：
10.1007/pl00014637
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发表时间：
1997
期刊：
影响因子：
--
通讯作者：
Reith Hb
中科院分区：
文献类型：
--
作者：
Reith Hb
急性坏死性胰腺炎和壶状或弥漫性化脓性腹膜炎是导致腹部外科感染死亡的主要原因。最近的数字表明，这一专门治疗组的死亡率仍然高达50%-80%。毫无疑问，病灶的手术清洁是最重要的治疗措施。在该疾病类别的几乎所有患者中经常观察到全身性炎症反应。局部手术治疗对预后影响最大。如果第一次干预没有达到治疗目标，辅助手术治疗是必要的。不同的形式是连续腹腔灌洗（CPL），开放背腹灌洗，再剖腹或计划再次手术（“Etappenlavage”）。辅助药物治疗包括TNF α和白细胞介素-1合成抑制剂或抗体。不幸的是，这些介质的临床研究在亚组中仅部分成功，因此一般的临床辅助治疗被认为是不可行的。牛磺罗定的细菌性质破坏细菌膜，同时导致膜组分和功能蛋白（LPS）的交联，从而同时发生杀菌作用和内毒素减少。可以使用局部和静脉内给药途径。
Acute necrotizing pancreatitis and fylecal or diffuse purulent peritonitis are the diseases primarily responsible for mortality due to surgical infections of the abdomen. The most recent figures indicate that a mortality rate of 50%-80% in this specialized treatment group is still a reality. Without doubt, surgical sanitation of the focus is the most important therapeutic measure. A generalized inflammation reaction has been regularly observed in nearly all patients within this disease category. Local surgical therapy has the greatest effect on prognosis. If the therapeutic goal is not reached with the first intervention, adjuvant surgical therapy is necessary. The different forms are continuous peritoneal lavage (CPL), open dorsoventral lavage, and relaparotomy or scheduled reoperation (" Etappenlavage"). Adjuvant medical treatments include TNF alpha and interleukin-1 synthesis inhibitors or antibodies. Unfortunately, clinical studies with these mediators have only been partly successful in the subgroups, so that a general clinical adjuvant treatment is not considered viable. The bacterial properties of taurolidine destroy the bacterial membrane and, at the same time, lead to cross-linking of the membrane components and functional proteins (LPS), so that a bactericidal effect and endotoxin reduction take place simultaneously. Both local and intravenous routes of administration can be used.