抗菌药物短程预防策略控制盆腔炎产妇剖宫产手术部位感染的效果评价  

The Evaluation of Surgical Site Infection Prevention by Short-term Antibiotic Prophylaxis Strategy for Cesarean Section in Patients with Pelvic Inflammatory Disease

作　　者：宁淑敏[1] 国心[1] 郝金玉[1] 郝晶[1] 陈静[1] 臧凤英[1] 周辉[1] 张玉荣[1] 郭朝辉[2] 高斌[1] 

机构地区：[1]天津市肝病医学研究所,天津市传染病医院,300192 [2]天津医科大学研究生院

出　　处：《天津医药》2011年第10期893-895,共3页Tianjin Medical Journal

基　　金：法国里尔大学医学院附属地区中心医院合作项目(项目编号:2005·5002);天津市卫生局科研项目(06KZ36)

摘　　要：目的:评价围手术期短程(<24h)抗菌药物使用策略预防盆腔炎产妇剖宫产后手术部位感染的效果。方法:选择于我院接受剖宫产术后存在盆腔炎的产妇227例,将患者按预防方式分为短程(<24h)组109例和长程(>48h)组118例。对2组患者产妇孕程、体质量指数、住院前时间、术前白细胞数,是否初产、胎膜早破、妊娠高血压综合征(妊高征)、以及手术部位感染、术后子宫内膜炎、产褥病率、血象变化、抗菌药的使用频度(DDDs)和费用、新生儿评分与感染进行比较。结果:2组产前基本情况、手术时间、术中出血差异无统计学意义(P>0.05);2组均未见手术部位感染,子宫内膜炎、产褥病率及血象升高等差异无统计学意义(P>0.05);短程与长程预防策略用于抗菌药的费用支出差异有统计学意义(P<0.01),短程策略抗菌药物的DDDs仅约是长程策略的1/7(P<0.01);同时新生儿评分与感染等差异亦无统计学意义(P>0.05)。结论:头孢唑啉或联合甲硝唑短程策略(<24h)预防盆腔炎产妇手术部位感染效果与长程用药策略(>48h)相当,抗菌药物费用和用量明显下降。Objective： To evaluate the effect of short-term prophylactic antibiotics （〈24 h） on prevention maternal/neo- natal infectious morbidity of cesarean section in patients with pelvic inflammatory disease （PID）. Methods： Two hundred and twenty-seven patients with PID were collected from patients with cesarean section. Patients were divided into 2 groups accord- ing to the short-term prophylaxis （〈24 hours, n= 109） or long-term prophylaxis （〉48 hours, n= 118）. It was compared between the two groups including maternal trimester, body mass index, white blood cell count before surgery primipara, premature rup- ture of membranes, pregnancy-induced hypertension syndrome and surgical site infection（SSI）, postoperative endometritis, pu- erperal morbidity, hemogram, frequency and cost of antibiotic defined daily dose （DDDs）, neonatal score and infection. Re- sults： There were no significant differences in the basic data, before operation, duration of surgery and blood loss during sur- gery between two groups （P 〉0.05）. Also there were no significant differences in the incidence of SSI, endometritis, puerperal morbidity and hemogram between two groups （P 〉 0.05）. It was found that the DDDs of short-term antibiotic prophylaxis strategy was 1/7 DDDs of long-term one （P 〈 0.01）, but no significant difference was found in the neonatal score and infection between two groups （P 〉 0.05）. Conclusion： The effect of short-term （〈24 hours） prophylaxis by cefazolin or combined with metronidazole was equivalent to the long-terna strategies （〉 48 h） in pelvic inflammatory diseases, with a decreased antibiotic usage and cost.

关 键 词：产妇 盆腔炎性疾病 剖宫产术 费用 药物 预防和防护用药 头孢唑林 甲硝唑 治疗结果 

分 类 号：R619.3[医药卫生—外科学]