Utzolino S, Hopt U T, Kaffarnik M
Universitätsklinikum der Albert-Ludwigs-Universität, Chirurgische Klinik, Freiburg, Abteilung Allgemein- und Viszeralchirurgie, Freiburg, Deutschland.
Zentralbl Chir. 2010 Jun;135(3):240-8. doi: 10.1055/s-0030-1247360. Epub 2010 Jun 14.
A high level of suspicion is necessary to detect postoperative sepsis in good time. It may be difficult to differentiate sepsis from normal SIRS in the postoperative setting. Early signs and symptoms include delirium and respiratory compromise. These should trigger the search for a septic focus aggressively with special attention to the original site of surgery. Key recommendations include early goal-directed resuscitation of the septic patient, administration of broad-spectrum antibiotic therapy within 1 hour of diagnosis, and source control with attention to the balance of risks and benefits of the chosen method. In cases of severe abdominal sepsis the concept of relaparotomy on-demand has become most popular.
要及时发现术后脓毒症，必须保持高度警惕。在术后情况下，可能难以将脓毒症与正常的全身炎症反应综合征区分开来。早期的体征和症状包括谵妄和呼吸功能不全。这些情况应促使积极寻找感染源，特别要关注手术的原部位。关键建议包括对脓毒症患者进行早期目标导向的复苏、在诊断后1小时内给予广谱抗生素治疗以及进行源头控制，同时要注意所选方法的风险和益处平衡。在严重腹部脓毒症的病例中，按需再次剖腹手术的概念最为流行。
