Lundberg C
Department of Otorhinolaryngology, Södersjukhuset, Karolinska Institute, Stockholm, Sweden.
Scand J Infect Dis Suppl. 1988;57:35-40.
Pathogenesis, prophylaxis and treatment of postoperative infections in the upper respiratory tract are discussed. Surgical procedures always hamper the normal mucosal defence system, which means that true pathogens and members of the normal flora can establish a heavy growth that will, inevitably, to some extent challenge the humoral and cellular defense of the mucosal and submucosal tissues. It is stressed that the activation of granulocytes and macrophages, which leads to the release of proteolytic proteases, can cause tissue destruction and thus also bacterial invasion. Prophylaxis should be based on good surgical technique, efficient drainage of the wound and prevention of accumulation of secretions. Antibiotic prophylaxis is recommended in risk situations, such as in extensive surgery and when the wound extends through the tissue from the skin to the mucosa. Postoperative infections have to be treated with surgical drainage and elimination of devitalized tissues in combination with antibiotic regimes based on results of bacteriological analysis.
本文讨论了上呼吸道术后感染的发病机制、预防和治疗。外科手术总会妨碍正常的黏膜防御系统，这意味着真正的病原体和正常菌群成员能够大量繁殖，不可避免地在一定程度上挑战黏膜和黏膜下组织的体液免疫和细胞免疫。需要强调的是，粒细胞和巨噬细胞的激活会导致蛋白水解酶的释放，进而引起组织破坏，也会导致细菌入侵。预防应基于良好的手术技术、伤口的有效引流以及防止分泌物积聚。在风险情况下，如进行大型手术以及伤口从皮肤延伸至黏膜穿过组织时，建议进行抗生素预防。术后感染必须通过手术引流和清除失活组织，并结合基于细菌学分析结果的抗生素治疗方案来进行治疗。
