Kreimer Flávio, Aguiar José Lamartine de Andrade, Castro Célia M M B, Lacerda Cláudio Moura, Reis Tarcisio, Lisboa Júnior Fernando
CCS- UFPE.
Acta Cir Bras. 2005;20 Suppl 1:63-71.
The acute peritonitis is an important cause of sepsis and death on intensive care units and surgery. The treatment must include: systemical use of antibiotics, drainage of abscess and restauration of gastrointestinal integrity. The topical use of antibiotics in the peritoneal cavity is controversial. The aim of this study was to evaluate the use of topical use of ampicilin/ sulbactam in the treatment of peritonitis.
We measured the plasmatic levels of nitric oxide, count of eosinophils, lymphocytes, monocytes, and neutrophils in blood and peritoneal cavity, using a model of peritonitis in rats (transfixation and ligature of cecum). Twenty four Wistar rats were divided in 4 groups (n = 6 each). group A: induction of peritonitis with ligature of cecum and topical treatment with saline; group B: induction of peritonitis with ligature of cecum and topical treatment with ampicilin/sulbactam; group C: transfixation of cecum; group D: laparotomy and peritoneal exsudate + blood sample. The transfixation-ligture of cecum remained for 24 hs before treatment. A relaparotomy was performed in 18 rats and peritoneal exsudate/blood were collected. Dosage of Nitric oxide, count of eosinophil, lymphocytes, monocytes, and neutrophils in blood and peritoneal exsudte were done.
The difference was not significant in the levels of nitric oxide, eosinophil, lymphocytes, monocytes, and neutrophils in blood and peritoneal exsudate (p > 0,05) among the studied groups.
The use of ampicilin associated to sulbactam via intraperitoneal in rats with fecal peritonitis did not change survival.; the levels of plama nitric oxide, count of eosinophil, lymphocytes, monocytes, and neutrophils in blood and peritoneal exsudate were not affected.
急性腹膜炎是重症监护病房和外科中脓毒症及死亡的重要原因。治疗必须包括：全身使用抗生素、脓肿引流以及恢复胃肠道完整性。抗生素在腹腔内的局部应用存在争议。本研究的目的是评估氨苄西林/舒巴坦局部应用于腹膜炎治疗的效果。
我们采用大鼠腹膜炎模型（盲肠穿刺和结扎），测量血液和腹腔内一氧化氮的血浆水平、嗜酸性粒细胞、淋巴细胞、单核细胞和中性粒细胞的计数。24只Wistar大鼠分为4组（每组n = 6）。A组：通过结扎盲肠诱导腹膜炎并局部用生理盐水治疗；B组：通过结扎盲肠诱导腹膜炎并局部用氨苄西林/舒巴坦治疗；C组：盲肠穿刺；D组：剖腹术及收集腹腔渗出液+血样。在治疗前，盲肠穿刺结扎保持24小时。对18只大鼠进行再次剖腹术并收集腹腔渗出液/血液。测定血液和腹腔渗出液中一氧化氮的剂量、嗜酸性粒细胞、淋巴细胞、单核细胞和中性粒细胞的计数。
在所研究的组中，血液和腹腔渗出液中一氧化氮、嗜酸性粒细胞、淋巴细胞、单核细胞和中性粒细胞的水平差异不显著（p > 0.05）。
在患有粪性腹膜炎的大鼠中，经腹腔给予氨苄西林联合舒巴坦并未改变生存率；血浆一氧化氮水平、血液和腹腔渗出液中嗜酸性粒细胞、淋巴细胞、单核细胞和中性粒细胞的计数未受影响。
