[Errors in lavage therapy in diffuse peritonitis].
The suppurative peritonitis is still one of the major clinical concerns for surgeons in these days. The presence of bacteria and endotoxins within the peritoneal cavity activate a chain of reactions, which mostly are still unknown, but frequently determinate the course of the disease. Because of the multifactorial system of the biochemical processes, we are coming to the paint to ask for a final chemical reaction of all these processes. The final reaction in this high toxic systems is taken place in an acidic pH range. Our experiments show, that the intraperitoneal alcalisation by lifting up the pH in the physiological range or even higher produces a stop in the septical reactions. Consequently because of these results we changed our treatment for severe peritonitis as followed: 1. Focus sanitation: Consequent treatment for the underlying cause of infection. 2. Continuous abdominal lavage over 4 catheters in each of the quadrants of the abdominal cavity with 101 of saline solution together with 8.4% Na-bicarbonate up to a pH-range of 7.6. 3. First revision of abdomen after 12 h after removing the catheters the normal intraoperative lavage with 10-15 1 saline solution with 8,5% Na-bicarbonate is performed. 4. The abdomen remains open and daily revisions and lavage with Na-bicarbonate are performed. 5. Early clinical data support the experimental findings.
Imhof
M
M
Chirurgische Universitätsklinik, Würzburg.
D000818:Animals; D001424:Bacterial Infections / Q000628:therapy*; D002254:Carbonates / Q000008:administration & dosage; D006863:Hydrogen-Ion Concentration; D010533:Peritoneal Lavage / Q000379:methods*; D010538:Peritonitis / Q000628:therapy*; D051381:Rats; D011919:Rats, Inbred Strains; D012965:Sodium Chloride / Q000008:administration & dosage
D002254:Carbonates; D012965:Sodium Chloride; C005686:sodium carbonate
Fehler in der Lavagetherapie bei der diffusen Peritonitis.