Schein M, Gecelter G, Freinkel W, Gerding H, Becker P J
Department of Surgery, J. G. Strijdom Hospital, Johannesburgh, South Africa.
Arch Surg. 1990 Sep;125(9):1132-5. doi: 10.1001/archsurg.1990.01410210058008.
The value of intraoperative peritoneal lavage (IOPL) with saline solution, with or without antibiotics, in the treatment of peritoneal contamination, continues to be controversial. A prospective trial was carried out in 87 patients who underwent emergency laparotomies for peritonitis. They were randomized to be treated in one of three ways: group 1 (mean acute physiologic and chronic health evaluation [APACHE] II score, 8) received no IOPL; group 2 (mean APACHE II score, 10) received IOPL with saline solution; and group 3 (mean APACHE II score, 8) received IOPL with saline solution and 2 g of chloramphenicol succinate. In groups 1, 2, and 3, the mortality was 21%, 21%, and 10%, respectively (not significant), and correlated well with the preoperative APACHE II scores. In groups 1, 2, and 3, the mean hospital stay was 13, 13, and 10 days, respectively (not significant), and the incidence of wound infections was 20%, 17%, and 17%, respectively; the incidence of surgical complications was 10%, 24% and 7%, respectively (not significant), and of medical complications, 24%, 31%, and 17%, respectively. We concluded that IOPL with saline solution or antibiotics did not influence the outcome following laparotomies for peritonitis.
术中用生理盐水进行腹腔灌洗（IOPL），无论是否添加抗生素，在治疗腹腔污染方面的价值一直存在争议。对87例因腹膜炎接受急诊剖腹手术的患者进行了一项前瞻性试验。他们被随机分为三种治疗方式之一：第1组（急性生理与慢性健康状况评估[APACHE]II评分均值为8）未接受IOPL；第2组（APACHE II评分均值为10）接受生理盐水IOPL；第3组（APACHE II评分均值为8）接受生理盐水IOPL加2g琥珀氯霉素。在第1、2和3组中，死亡率分别为21%、21%和10%（无显著差异），且与术前APACHE II评分密切相关。在第1、2和3组中，平均住院天数分别为13天、13天和10天（无显著差异），伤口感染发生率分别为20%、17%和17%；手术并发症发生率分别为10%、24%和7%（无显著差异），医疗并发症发生率分别为24%、31%和17%。我们得出结论，生理盐水或抗生素的IOPL对腹膜炎剖腹手术后的结果没有影响。
