Winkeltau G J, Töns C, Bertram P, Schumpelick V
Chirurgische Universitätsklinik der RWTH, Aachen.
Langenbecks Arch Chir. 1997;382(4 Suppl 1):S22-5. doi: 10.1007/pl00014639.
In a prospective protocol 25 consecutive patients with diffuse peritonitis were treated in the Surgical Clinic of the RWT-University in Aachen, Germany, from January to December 1995. According to the "Mannheim Peritonitis Score" three different stages were treated with different surgical procedures and a selective antibiotic regimen. Group-A patients with prognostically favorable peritonitis (MPS 0-20) were treated with the so-called standard procedure, group-B patients (MPS: 21-29) with closed postoperative lavage. The antibiotic regimen was cefotaxime (2 x 2 g) and metronidazole (2 x 500 mg) for both group-A and group-B patients. Severe group-C cases (MPS > 29) were treated with the so-called Etappenlavage (multiple reexplorations and intra-operative lavage) and received a combination of three antibiotics (2 x 2 g cefotaxime; 2 x 500 mg metronidazole and 2 x 200 mg ofloxacin).
Eight patients belonged to group A, 10 to group B, and 7 to group C. The mortality was 0% (group A), 20% (group B), and 29% (group C), respectively. The actual overall mortality of the whole group was 16% (4/25). The statistically expected mortality was 36%, according to the APACHE-II-Score (P = 0.0982).
1995年1月至12月，在德国亚琛RWTH大学外科诊所，按照前瞻性方案对25例连续性弥漫性腹膜炎患者进行了治疗。根据“曼海姆腹膜炎评分”，三个不同阶段采用了不同的外科手术方法和选择性抗生素治疗方案。A组为预后良好的腹膜炎患者（曼海姆腹膜炎评分0 - 20分），采用所谓的标准手术方法治疗；B组患者（曼海姆腹膜炎评分：21 - 29分）采用术后闭式灌洗治疗。A组和B组患者的抗生素治疗方案均为头孢噻肟（2×2g）和甲硝唑（2×500mg）。C组严重病例（曼海姆腹膜炎评分>29分）采用所谓的分期灌洗（多次再次探查和术中灌洗）治疗，并接受三种抗生素联合治疗（2×2g头孢噻肟；2×500mg甲硝唑和2×200mg氧氟沙星）。
A组有8例患者，B组有10例患者，C组有7例患者。死亡率分别为0%（A组）、20%（B组）和29%（C组）。整个组的实际总死亡率为16%（4/25）。根据急性生理与慢性健康状况评分系统II（APACHE-II）评分，统计学预期死亡率为36%（P = 0.0982）。
