Price Institute of Surgical Research, Louisville, Kentucky, USA.
Br J Surg. 2010 Feb;97(2):151-9. doi: 10.1002/bjs.6906.
: Morbidity and mortality associated with bacterial peritonitis remain a challenge for contemporary surgery. Despite great surgical improvements, death rates have not improved. A secondary debate concerns the volume and nature of peritoneal lavage or washout-what volume, what carrier and what, if any, antibiotic or antiseptic?
: A literature search of experimental studies assessing the effect of peritoneal lavage following peritonitis was conducted using Medline, EMBASE and Cochrane databases. Twenty-three trials met predetermined inclusion criteria. Data were pooled and relative risks calculated.
: In an experimental peritonitis setting a mortality rate of 48.9 per cent (238 of 487) was found for saline lavage compared with 16.4 per cent (106 of 647) for antibiotic lavage (absolute risk reduction (ARR) 32.5 (95 per cent confidence interval (c.i.) 27.1 to 37.7) per cent; (P < 0.001). An ARR of 25.0 (95 per cent c.i. 17.9 to 31.7) per cent P < 0.001) was found for the use of saline compared with no lavage at all. The survival benefit persisted regardless of systemic antibiotic therapy. Antiseptic lavage was associated with a very high mortality rate (75.0 per cent).
: Pooled data from studies in experimental peritonitis demonstrated a significant reduction in mortality with antibiotic lavage.
细菌性腹膜炎相关的发病率和死亡率仍然是当代外科手术的一个挑战。尽管外科技术有了很大的进步，但死亡率并没有改善。第二个争论涉及到腹腔灌洗或冲洗的量和性质——多少量，什么载体，以及如果使用抗生素或防腐剂，使用哪种抗生素或防腐剂？
使用 Medline、EMBASE 和 Cochrane 数据库对评估腹膜炎后腹腔灌洗效果的实验研究进行了文献检索。符合预定纳入标准的 23 项试验。对数据进行了汇总，并计算了相对风险。
在实验性腹膜炎模型中，生理盐水灌洗的死亡率为 48.9%（238/487），而抗生素灌洗的死亡率为 16.4%（106/647）（绝对风险降低（ARR）为 32.5%（95%置信区间（CI）为 27.1%至 37.7%）；（P < 0.001）。与根本不灌洗相比，生理盐水灌洗的 ARR 为 25.0%（95%CI 为 17.9%至 31.7%）（P < 0.001）。无论是否全身使用抗生素治疗，这种生存获益都持续存在。防腐剂灌洗与非常高的死亡率相关（75.0%）。
来自实验性腹膜炎研究的汇总数据表明，抗生素灌洗可显著降低死亡率。
