[腹膜炎：外科重症监护中严重脓毒症的主要原因]

[Peritonitis: main reason of severe sepsis in surgical intensive care].

作者信息

Weiss G, Steffanie W, Lippert H

机构信息

Klinik für Allgemein-, Viszeral- und Gefässchirurgie, Otto-von-Guericke-Universität, Magdeburg, Deutschland.

出版信息

Zentralbl Chir. 2007 Apr;132(2):130-7. doi: 10.1055/s-2006-960478.

DOI:10.1055/s-2006-960478

PMID:17516319

Abstract

INTRODUCTION

Aim of the study was to determine the epidemiology of sepsis in an university surgical intensive care unit. We were mainly interested in getting information about incidence, reason and clinical course of peritonitis. The results should give more information about diagnostic and therapy of sepsis in the surgical intensive care.

METHODS

We analyzed our 2 676 ICU-patients from 2000 to 2002 with infection as main diagnosis. By means of medical report we analyzed the kind of infection and the clinical course of 561 (21 %) patients. For 356 (13.3 %) patients with peritonitis we observed the kind, the reason and the severity of infection and further the special events in the clinical course.

RESULTS

The incidence of severe sepsis was 14.8 %. With 63 % the peritonitis is the main infectiological diagnosis on admission to ICU. 33.8 % of infections are hospital acquired. 71.3 % of patients with peritonitis developed a severe sepsis or septic shock during the clinical course. On average 4.7 further abdominal surgical interventions and 5.1 new occurring nosocomial infections marked a difficult surgical and infectious treatment course. Hospital acquired infections (70 %), high value of scoring and inadequate surgical treatment (23.7 %) have proved to be a good prognostic instrument for the development of tertiary peritonitis. With a share of 17 % from patients with peritonitis and a mortality of 35 % they have a strong influence on the ICU-mortality.

CONCLUSION

Peritonitis is the main reason of severe sepsis on the surgical ICU. Hospital acquired infections especially the tertiary peritonitis have the highest mortality. High mortality is the consequence from the large number of difficult clinical courses and high rates of severe sepsis and septic shock. "Second hits" play a crucial role for the therapy and the prognosis of these patients. To decline the mortality future studies must more consider the problem of hospital acquired and tertiary abdominal infections.

摘要

引言

本研究的目的是确定某大学外科重症监护病房中脓毒症的流行病学情况。我们主要关注获取有关腹膜炎的发病率、病因及临床病程的信息。研究结果应能为外科重症监护中脓毒症的诊断和治疗提供更多信息。

方法

我们分析了2000年至2002年期间以感染作为主要诊断的2676例重症监护病房患者。通过病历分析了561例（21%）患者的感染类型及临床病程。对于356例（13.3%）患有腹膜炎的患者，我们观察了感染的类型、病因及严重程度，以及临床病程中的特殊事件。

结果

严重脓毒症的发病率为14.8%。腹膜炎是入住重症监护病房时主要的感染性诊断，占63%。33.8%的感染是医院获得性感染。71.3%的腹膜炎患者在临床病程中发展为严重脓毒症或脓毒性休克。平均而言，4.7次进一步的腹部外科手术干预以及5.1次新发生的医院感染标志着外科和感染治疗过程艰难。医院获得性感染（70%）、高评分值以及不充分的外科治疗（23.7%）已被证明是发生继发性腹膜炎的良好预后指标。继发性腹膜炎患者占腹膜炎患者的17%，死亡率为35%，它们对重症监护病房的死亡率有很大影响。