Bondar V M, Rago C, Cottone F J, Wilkerson D K, Riggs J
Department of Surgery, St Francis Medical Center, Trenton, NJ, USA.
Arch Surg. 2000 Mar;135(3):309-14. doi: 10.1001/archsurg.135.3.309.
Closed postoperative peritoneal lavage (CPPL) with chlorhexidine gluconate reduces the number of intraperitoneal bacteria and improves the outcome of intra-abdominal infection.
Laboratory animal trial.
Intra-abdominal infection was produced in mice by the cecal ligation and puncture technique. After 16 to 18 hours, the animals underwent relaparotomy and placement of an intra-abdominal catheter for CPPL. In the first experiment animals were randomly divided into 4 groups: no lavage (served as a control), CPPL with chlorhexidine. CPPL with cefoxitin, and CPPL with lactated Ringer solution (LR). Lavage was continued intermittently every 8 hours for 24 hours. All animals received systemic cefoxitin every 8 hours for 7 days. Mortality was recorded every 8 hours for 10 days. In the second experiment, animals were divided into 3 groups: no lavage (served as a control), CPPL with chlorhexidine, and CPPL with LR. Lavage was continued intermittently every 8 hours for 24 hours. The animals were killed 48 hours after reoperation. Bacterial counts from peritoneal fluid and biopsy specimens, as well as peritoneal white blood cell counts, were measured before and after lavage.
Closed postoperative peritoncal lavage with chlorhexidine reduced mortality from 71% in a control group to 37% (P = .003). There was no survival benefit in either the CPPL with cefoxitin (91% mortality) (P = .14) or CPPL with LR groups (90% mortality) (P = .17). The statistically significant findings of analysis of variance evaluation demonstrated a decrease in bacterial counts after cecal excision in all 3 groups. There was a greater reduction in bacterial counts in the chlorhexidine group compared with the control group (P<.05). Bacterial counts decreased in peritoneal fluid, as well as in tissue biopsy specimens, after cecal excision. White blood cell counts significantly decreased after cecal excision in all 3 groups. There was no difference in white blood cell counts between the groups. Correlation analyses demonstrated weak interaction between bacterial and white blood cell counts before or after treatment in all the groups. Pearson r ranged from -0.37 to +0.35, none of which were statistically significant.
In our experiments chlorhexidine lavage resulted in a 50% reduction in mortality and a significant reduction in bacterial counts compared with the control group. There was no survival benefit from lavage with either cefoxitin or LR. There was no reduction in bacterial counts in the LR group relative to the control group. Thus, the survival benefit and the reduction in bacterial numbers are attributed to the antibacterial properties of chlorhexidine rather than to the mechanical washing of the abdominal cavity. Closed postoperative peritoneal lavage with 0.05% chlorhexidine gluconate might be useful in the multimodal treatment of intra-abdominal infection.
用葡萄糖酸氯己定进行术后封闭腹腔灌洗（CPPL）可减少腹腔内细菌数量并改善腹腔感染的预后。
实验动物试验。
采用盲肠结扎和穿刺技术在小鼠中制造腹腔感染。16至18小时后，对动物进行再次剖腹手术并放置腹腔导管用于CPPL。在第一个实验中，动物被随机分为4组：不灌洗（作为对照组）、用葡萄糖酸氯己定进行CPPL、用头孢西丁进行CPPL以及用乳酸林格液（LR）进行CPPL。每8小时间歇灌洗持续24小时。所有动物每8小时接受一次全身性头孢西丁治疗，共7天。每8小时记录一次死亡率，持续10天。在第二个实验中，动物被分为3组：不灌洗（作为对照组）、用葡萄糖酸氯己定进行CPPL以及用LR进行CPPL。每8小时间歇灌洗持续24小时。再次手术后48小时处死动物。在灌洗前后测量腹腔液和活检标本的细菌计数以及腹腔白细胞计数。
用葡萄糖酸氯己定进行术后封闭腹腔灌洗使死亡率从对照组的71%降至37%（P = 0.003）。用头孢西丁进行CPPL组（死亡率91%）（P = 0.14）或用LR进行CPPL组（死亡率90%）（P = 0.17）均未显示出生存获益。方差分析评估的统计学显著结果表明，所有3组在盲肠切除后细菌计数均减少。与对照组相比，葡萄糖酸氯己定组的细菌计数减少幅度更大（P<0.05）。盲肠切除后，腹腔液以及组织活检标本中的细菌计数均下降。所有3组在盲肠切除后白细胞计数均显著下降。各组之间白细胞计数无差异。相关性分析表明，所有组在治疗前后细菌计数与白细胞计数之间的相互作用较弱。Pearson相关系数r在-0.37至+0.35之间，均无统计学意义。
在我们的实验中，与对照组相比，用氯己定灌洗使死亡率降低了50%，细菌计数显著减少。用头孢西丁或LR灌洗均未显示出生存获益。与对照组相比，LR组的细菌计数没有减少。因此，生存获益和细菌数量的减少归因于氯己定的抗菌特性，而非腹腔的机械冲洗。用0.05%葡萄糖酸氯己定进行术后封闭腹腔灌洗可能有助于腹腔感染的多模式治疗。
