Nyström P O
Department of Medico-Surgical Gastroenterology, Linköping University Hospital, Sweden.
Eur J Surg Suppl. 1996(576):42-6.
After reviewing the processes leading from contamination to infection and its clinical implications I conclude that outcome after emergency colonic surgery in general is the result of three factors: elimination of the surgical problem; extent of preoperative physiological derangement; and the patient's immediate response to intensive care and surgery. Antibiotic treatment is important but secondary. For most patients with minor contamination and infection, including appendicitis and trauma, the duration of antibiotic administration following emergency surgery has been established to be one or at most four doses. Patients in the intensive care units need individualised treatment. There is a minor group treated outside intensive care units but with substantial infection where the duration should be re-evaluated in new trials, preferably by comparing short and long duration in randomised fashion.
在回顾了从污染到感染的过程及其临床意义后，我得出结论，一般来说，急诊结肠手术后的结果是由三个因素决定的：手术问题的解决；术前生理紊乱的程度；以及患者对重症监护和手术的即时反应。抗生素治疗很重要，但处于次要地位。对于大多数有轻微污染和感染的患者，包括阑尾炎和创伤患者，急诊手术后抗生素的使用时长已确定为一剂或最多四剂。重症监护病房的患者需要个体化治疗。有一小部分患者在重症监护病房之外接受治疗，但感染情况严重，在新的试验中应重新评估抗生素使用时长，最好通过随机方式比较短时长和长时长的效果。
