Matolo N M, Cohen S E, Wolfman E F
Am Surg. 1976 Feb;42(2):123-7.
A prospective study was undertaken on 102 patients with massice intraperitoneal contamination from traumatic or spontaneous perforation of intestinal or pancreaticobiliary tract to determine the effects of combined systemic and intraperitoneal antibiotic administration on the prevention of the postoperative sepsis, intra-abdominal abscess formation and wound infection. Large doses of gentamicin and clindamycin were given parenterally before, during, and after the operation for five days. In addition, the peritoneal cavity and the abdominal incision were irrigated intraoperatively with antibiotic solution containing the same antibiotics. The drugs were given so as to provide a potent level of antibiotics during the operation and in the immediate postoperative period. The postoperative wound infection rate was 4 per cent, intra-abdominal abscess 2.9 per cent, sepsis 1 per cent, resulting in a total infectious complication rate of 7.9 per cent. This is a marked reduction in the incidence of infectious complications and compares favorably with the results from either parenteral or intraperitoneal therapy alone. Furthermore, no complications were encountered due to this method of therapy. These results do not indicate that antimicrobial drugs be given prophylactically to all surgical patients, but they strongly suggest the advantages of combined systemic and intraperitoneal antibiotics in the management of patients with massive intraperitoneal contamination.
对102例因肠道或胰胆管创伤性或自发性穿孔导致大量腹腔内污染的患者进行了一项前瞻性研究，以确定全身和腹腔内联合使用抗生素对预防术后败血症、腹腔内脓肿形成和伤口感染的效果。在手术前、手术期间和手术后五天，静脉注射大剂量庆大霉素和克林霉素。此外，术中用含有相同抗生素的抗生素溶液冲洗腹腔和腹部切口。给药方式是为了在手术期间和术后即刻提供有效的抗生素水平。术后伤口感染率为4%，腹腔内脓肿为2.9%，败血症为1%，总感染并发症率为7.9%。这是感染并发症发生率的显著降低，与单独采用全身或腹腔内治疗的结果相比具有优势。此外，这种治疗方法未出现并发症。这些结果并不表明所有外科患者都应预防性使用抗菌药物，但它们强烈提示了全身和腹腔内联合使用抗生素在治疗大量腹腔内污染患者中的优势。
