人工关节置换围手术期预防性应用不同抗生素血清的最佳时机  

Best occasion for prophylactic application of different antibiotic serums in the perioperative prosthetic replacement

作　　者：樊宇平[1] 蔡諝[1] 方毅[2] 王岩[1] 刘玉杰[1] 王志刚[1] 

机构地区：[1]解放军总医院骨科,北京市100853 [2]解放军总医院药理实验室,北京市100853

出　　处：《中国临床康复》2006年第13期104-106,共3页Chinese Journal of Clinical Rehabilitation

摘　　要：目的:人工关节置换术患者围手术期预防性应用不同的抗生素血清的最佳时机分析。方法:于2000-05/2001-03解放军总医院骨科行人工关节置换术患者90例,随机分为6组,术前1d、术前1h、手术开始后30min分别静脉滴注青霉素类氨苄青霉素1.5g和头孢类头孢呋辛2.0g,每组15例,皮试无药物过敏。采集手术开始时周围静脉血、首侧肢体切骨时骨质渗血、次侧肢体切骨时骨面出血、手术结束时引流管引流血10mL,备测。采用微量稀释法作血清杀菌活性(无菌生长的最低血清稀释倍数)测定,比较不同给药时间、不同时段术野出血的抗菌效能。结果:纳入患者90例,均进入结果分析。①不同抗生素血清杀菌活性的比较:氨苄青霉素和头孢呋辛对临床常见致病菌的血清杀菌活性接近。②不同时段抗生素血清杀菌活性≥1∶8比较:术前1d给药,术野血清杀菌活性微弱。氨苄青霉素于术前1h给药在手术开始至处理首侧肢体切骨时以及手术开始后30min给药在首侧肢体切骨至次侧肢体切骨时血清杀菌活性≥1∶8大于其他时段,差异显著(P<0.05);头孢呋辛于术前1h给药在手术开始至首侧肢体切骨时以及手术开始后30min给药在次侧肢体切骨至手术结束时血清杀菌活性≥1∶8大于其他时段,差异显著(P<0.05)。结论:术前1h至手术开始后静脉应用抗生素可在关节假体植入的主要阶段保持较高的术野血抗菌效能,从而有可能进一步减少术后感染的机会。但是不同抗生素的应用时机还应根据其药代动力学的差异进行相应调整。AIM： To analyze the best occasion for prophylactic application of different antibiotic serums in the pefioperative prosthetic replacement. METHODS： Totally 90 patients who underwent prosthetic replacement in the Department of Hospital, General Hospital of Chinese PLA between May 2000 and March 2001 were randomly divided into 6 groups： Ampicillin （UNASYN, 1,5 g） and cefuroxime axetil （Zinacef, 2.0 g） were administered by intravenous infusion respectively one day or one hour before operation or 30 minutes after the operation. There were 15 cases in each group, and no one had drug allergy. 10 mL blood samples were collected from peripheral vein, cancellous bone when first reaming, cancellous bone when second reaming and catheter fight after the operation, Serum bactericidal activities （SBAs） were determined by minim dilution technique and the antimicrobial effect was compared between different administered time and different areas for blood collection, RESULTS： Totally 90 patients were enrolled in the experiment, and all of them entered the stage of result analysis. ① Comparison of bactericidal activities of different antibiotics serum： SBAs of UNASYN and Zinacef were similar to the bacteria, most commonly causing infection after prosthesis implantation such as staphylococcus, ②Comparison of SBA ≥ 1：8 of UNASYN and Zinacef at different time periods： SBA was weak when the administration was performed 1 day before operation. Percentage at SBA ≥ 1：8 of UNASYN and Zinacef were significantly more at the beginning of operation and when first reaming than the other groups （P 〈 0.05） if they were administered one hoar before operation. Percentage at SBA ≥ 1：8 of UNASYN when it was administered 30 minutes after the operation began was more when first reaming and second reaming than the other stages （P 〈 0.05）. But percentage at SBA≥ 1：8 of Zinacef when it was administered 30 minutes after the operation began was when first reaming and at the end of operation than the

关 键 词：关节成形术 置换 髋 关节成形术 置换 膝 抗生素预防 血清杀菌实验 

分 类 号：R681.6[医药卫生—骨科学]