Heller K, Waag K L
Kinderchirurgie, Klinikum der J.-W.-Goethe-Universität Frankfurt/Main.
Z Kinderchir. 1987 Aug;42(4):241-5. doi: 10.1055/s-2008-1075594.
Between 1981 and 1985, 15 neonates and young infants, who suffered from severe putrid or faecal peritonitis due to perforation of the gastrointestinal tract, were treated by intermittent postoperative peritoneal lavage. During the operation 2 to 4 drains were inserted into the peritoneal cavity. Immediately after operation peritoneal lavage was started with 20 ml/kg body weight Ringer or peritoneal dialysis solution. Inflow of the solution was done during a 20 minutes period. The solution then remained in the peritoneal cavity for another 20 min., before the 20 min. outflow was started (tidal-like rhythm). We did not use antibiotics or antiseptics in addition to the saline fluid to prevent damage to the tissue and adhesions of the bowel. Serum electrolytes, blood urea and body temperature can be changed by variation of the solution. After the operation the patients must remain in the intensive care unit. Accurate and detailed documentation of the balance of the inflow and outflow is very important. Five of the fifteen treated infants died due to additional malformations and complications following sepsis. All of them were premature with necrotising enterocolitis. Our experience with intermittent peritoneal lavage in selected patients suggest to use it in the management of infants with severe peritonitis due to perforation of the intestine.
1981年至1985年间，15例因胃肠道穿孔导致严重腐败性或粪性腹膜炎的新生儿和婴幼儿接受了术后间歇性腹膜灌洗治疗。手术过程中，在腹腔内插入2至4根引流管。术后立即用20毫升/千克体重的林格氏液或腹膜透析液开始腹膜灌洗。溶液在20分钟内流入。然后溶液在腹腔内再保留20分钟，之后开始20分钟的流出（类似潮汐的节律）。除生理盐水外，我们未使用抗生素或防腐剂，以防止对组织造成损伤和肠道粘连。血清电解质、血尿素和体温可因溶液的变化而改变。术后患者必须留在重症监护病房。准确详细记录出入量平衡非常重要。15例接受治疗的婴儿中有5例因败血症后的其他畸形和并发症死亡。他们均为患有坏死性小肠结肠炎的早产儿。我们在部分患者中进行间歇性腹膜灌洗的经验表明，可将其用于治疗因肠道穿孔导致严重腹膜炎的婴儿。
