胃肠外科围手术期手术部位感染的预防与治疗策略

手术部位感染（SSI）是胃肠外科围手术期常见的并发症之一。SSI可增加胃肠外科患者的并发症发生率与病死率．延长住院时间．增加住院费用。患者、经治医生和医院环境均有发生SSI的风险因素。在改善患者营养状态、减轻脏器功能障碍和合理控制血糖的同时．针对我国外科实践,急需改进并推广的预防措施包括：术前剪除手术野毛发：术前0．5～2h内使用预防性针对切口致病菌的抗感染药物;术中使用接近体温的生理盐水冲洗腹腔：使用可吸收缝线或抗菌的可吸收缝线连续缝合切口皮下各层;少放引流物并及时拔除引流物。综合患者症状、体征、血白细胞计数和降钙素原检测可早期诊断SSI．腹部CT有助于诊断腹腔深部和后腹膜感染。针对SSI中的浅层与深层切口感染．应采用逐层清创的原则：对腹腔和后腹膜深层感染或危重患者．可采用B超或CT引导下的经皮脓肿穿刺引流;对腹腔感染范围较为广泛的患者可适时再次开腹．开腹手术应贯彻损伤控制的理念．达到控制感染源和通畅引流的目的即可,避免损伤肠管：应在抗感染药物使用前获得相应的脓液标本送细菌培养,以指导抗感染药物的使用。

Current practice in the prevention and management of surgical site infections in gastrointestinal surgery

Surgical site infection(SSI) is one of post-operative complications in gastrointestinal surgery. SSI may increase the morbidity and mortality of surgical patients and increase their hospital stay and expense. The risk factors can come from patients, physicians and hospital environments. Improving patients nutritional status and organ function, appropriate control of blood sugar level and abstinence from smoking can reduce the occurrence of SSI. Compare to current practice in China, the following recommendations have been identified as priorities for implementation: hair removal done immediately before operation; maintenance of normothermia intraoperatively; the abdominal wall should be closed with an absorbable suture and drains should be removed as early as possible. SSI could be diagnosed by symptoms, local signs and lab examinations and confirmed by physician. Source control is the key point in the management of SSI. Ultrasound and CT guided percutaneous abscess drainage is effective in the localized deep space surgical site infection and critically ill patients. Antibiotics should be used following clinical assessment and evidence based on local formulary.