腹部救急手術後の敗血症合併症予防におけるタウロリンの使用

[Use of taurolin in the prevention of septic complications in emergency abdominal surgery].

• M Popović
• D Dugalni
• M Milićević
• M Petrović
• M Zuvela
• S Knezević
• Z Janković

抄録

本研究の目的は、腹部救急手術後の敗血症合併症予防におけるタウロリンの局所適用の有効性を評価することであった。A群には30例が含まれ，術中腹膜ラバージにタウロリン0.5%溶液を投与した．術後12時間以内にドレーンからの腹膜洗浄を繰り返した。B群は30例で、生理食塩水またはポビドン溶液を用いて腹腔内洗浄を行った。すべての患者は腹部臓器の穿孔による化膿性腹膜炎を呈していた。術中は細菌学的分析のために腹腔内の膿を採取し、術後は腹腔内と皮下に設置したドレーンから採取した。術後12時間後には、手術所見、術後経過、レントゲン所見、検査所見、感度試験の結果に応じた治療を行った。その結果を分析したところ、術後の罹患率と死亡率に両群間で有意差が認められた。術直後の経過では、A群では再発腹腔内感染が1例のみ、創部感染が3例で、致命的な転帰は記録されていなかった。一方、B群では、術直後の死亡は3例、再発性腹腔内感染は4例、創部感染は12例であった。適切な手術治療と術後ケアに加えて、タウロリンの術中・術後早期の局所適用は、術後の敗血症合併症の予防と術後死亡率の低下に重要な役割を果たしている。

The purpose of the study was to evaluate effectiveness of local application of Taurolin in prevention of septic complications after abdominal emergency surgery. Group A included 30 patients in whom intraoperative peritoneal lavage was performed with 0.5% solution of taurolin. In the first 12 postoperative hours peritoneal lavage was repeated through the drain. Group B included 30 patients in whom intraoperative lavage was performed with either physiologic saline or Povidon solution. All patients had suppurative peritonitis provoked by perforation of some of the abdominal organs. Intraoperatively samples of abdominal pus were taken for bacteriological analysis, while postoperatively samples were taken from drains placed abdominally and subcutaneously. Twelve hours after the surgery therapy was conducted according to the operative findings, postoperative course, x-ray and laboratory findings and results of sensitivity testing. Analysis of the results revealed significant differences in postoperative morbidity and mortality between the two groups. No fatal outcomes were recorded in the immediate postoperative course in group A where only one case of recurrent intraperitoneal infection occurred and three cases of wound infection. In group B, however, three patients died in the immediate postoperative course, recurrent intraperitoneal infection developed in four cases and wound infection in 12. Intraoperative and early postoperative local application of Taurolin in addition to appropriate surgical treatment and postoperative care has an important role in prevention of postoperative septic complications and decrease of postoperative mortality.