Abstract：
OBJECTIVE: The abdomen is the second most common source of sepsis and secondary peritonitis, which likely lead to death. In the present study, we hypothesized that instillation of local anesthetics into the peritoneum might mitigate the systemic inflammatory response syndrome (SIRS) in the open abdomen when combined with negative-pressure therapy (NPT) to treat severe peritonitis.
METHODS: We performed a study in 21 pigs applying a model of sepsis based on ischemia/reperfusion and fecal spread into the peritoneum. The pigs were randomized into three groups, and treated for 6 h as follows: Group A: temporary abdominal closure with ABTHERA™ Open Abdomen Negative-Pressure Therapy; Group B: temporary abdominal closure with ABTHERA™ Open Abdomen Negative-Pressure Therapy plus abdominal instillation with physiological saline solution (PSS); and Group C: temporary abdominal closure with ABTHERA™ Open Abdomen Negative-Pressure Therapy plus peritoneal instillation with a solution of ropivacaine in PPS.
RESULTS: A comparison between the three groups revealed no statistically significant difference for any of the parameters registered (p > 0.05), i.e., intra-abdominal pressure, blood pressure, heart rate, O2 saturation, diuresis, body temperature, and blood levels of interleukin 6 (IL-6), tumor necrosis factor alpha (TNFα), and c-reactive protein (CRP). In addition, histological studies of the liver, ileum, kidney and lung showed no difference between groups.
CONCLUSIONS: The use of abdominal instillation (with or without ropivacaine) did not change the effect of 6 h of NPT after sepsis in animals with open abdomen. The absence of adverse effects suggests that longer treatments should be tested.
METHODS: We performed a study in 21 pigs applying a model of sepsis based on ischemia/reperfusion and fecal spread into the peritoneum. The pigs were randomized into three groups, and treated for 6 h as follows: Group A: temporary abdominal closure with ABTHERA™ Open Abdomen Negative-Pressure Therapy; Group B: temporary abdominal closure with ABTHERA™ Open Abdomen Negative-Pressure Therapy plus abdominal instillation with physiological saline solution (PSS); and Group C: temporary abdominal closure with ABTHERA™ Open Abdomen Negative-Pressure Therapy plus peritoneal instillation with a solution of ropivacaine in PPS.
RESULTS: A comparison between the three groups revealed no statistically significant difference for any of the parameters registered (p > 0.05), i.e., intra-abdominal pressure, blood pressure, heart rate, O2 saturation, diuresis, body temperature, and blood levels of interleukin 6 (IL-6), tumor necrosis factor alpha (TNFα), and c-reactive protein (CRP). In addition, histological studies of the liver, ileum, kidney and lung showed no difference between groups.
CONCLUSIONS: The use of abdominal instillation (with or without ropivacaine) did not change the effect of 6 h of NPT after sepsis in animals with open abdomen. The absence of adverse effects suggests that longer treatments should be tested.
摘要：
目的：腹部是败血症和继发性腹膜炎的第二常见来源，这可能会导致死亡。在本研究中,我们假设,在联合负压治疗(NPT)治疗严重腹膜炎时,向腹膜内滴注局部麻醉药可能会减轻开腹全身炎症反应综合征(SIRS).
方法：我们在21头猪中进行了一项研究，该研究应用了基于缺血/再灌注和粪便扩散到腹膜中的脓毒症模型。将猪随机分为三组，并治疗6小时，如下：A组：ABTHERA™开腹负压疗法的临时腹部闭合；B组：ABTHERA™开腹负压疗法的临时腹部闭合加生理盐水溶液（PSS）的腹腔滴注；C组：ABTHERA™开腹负压疗法的临时腹部闭合加腹膜滴注罗哌卡因溶液的PPS。
结果：三组之间的比较显示，所记录的任何参数均无统计学意义（p>0.05），即，腹内压,血压,心率,O2饱和度,利尿,体温,和白细胞介素6（IL-6）的血液水平，肿瘤坏死因子α（TNFα），和C反应蛋白（CRP）。此外,肝脏的组织学研究，回肠,肾和肺两组间无差异。
结论：在腹部开放的动物中，使用腹部滴注（有或没有罗哌卡因）不会改变脓毒症后6小时NPT的效果。没有不良反应表明应该测试更长的治疗。
方法：我们在21头猪中进行了一项研究，该研究应用了基于缺血/再灌注和粪便扩散到腹膜中的脓毒症模型。将猪随机分为三组，并治疗6小时，如下：A组：ABTHERA™开腹负压疗法的临时腹部闭合；B组：ABTHERA™开腹负压疗法的临时腹部闭合加生理盐水溶液（PSS）的腹腔滴注；C组：ABTHERA™开腹负压疗法的临时腹部闭合加腹膜滴注罗哌卡因溶液的PPS。
结果：三组之间的比较显示，所记录的任何参数均无统计学意义（p>0.05），即，腹内压,血压,心率,O2饱和度,利尿,体温,和白细胞介素6（IL-6）的血液水平，肿瘤坏死因子α（TNFα），和C反应蛋白（CRP）。此外,肝脏的组织学研究，回肠,肾和肺两组间无差异。
结论：在腹部开放的动物中，使用腹部滴注（有或没有罗哌卡因）不会改变脓毒症后6小时NPT的效果。没有不良反应表明应该测试更长的治疗。
