冠状动脉旁路移植术后手术部位感染的配对研究  

Paired study of surgical site infections after the coronary artery bypass grafting surgery

作　　者：孟黎辉[1] 李夏明[1] 李京明[1] 施颖[1] 束冬兰[1] 武迎宏[2] 

机构地区：[1]首都医科大学附属北京安贞医院医院感染管理办公室,北京100029 [2]北京大学人民医院医院感染管理办公室,北京100044

出　　处：《中华医院感染学杂志》2013年第13期3149-3150,共2页Chinese Journal of Nosocomiology

基　　金：首都医学发展科研基金(2011-管-04)

摘　　要：目的分析冠状动脉旁路移植术(CABG)后手术部位感染(SSI)患者和非感染患者的抗菌药物预防使用情况和部分临床指标,为合理使用抗菌药物提供依据。方法对北京市9所医院2008-2010年的CABG手术进行前瞻性目标性监测,将发生SSI的62例患者作为SSI组,未发生感染的124例患者作为对照组,分析两组患者围术期抗菌药物使用、术后早期血像和体温等临床指标。结果 SSI组和对照组患者抗菌药物使用率均为100.0%,联合预防用药率分别为81.42%和79.29%,预防用药时间分别为(11.18±1.12)d和(10.95±0.98)d,两组差异无统计学意义;SSI组和对照组术后24～48h白细胞绝对值分别为(18.2±0.48)、(17.9±0.92)k/μl,术后72h患者体温分别为(37.8±0.86)、(38.0±0.24)℃,两组差异无统计学意义。结论预防SSI不应单纯依赖长时间、联合使用抗菌药物,术后早期血像升高、体温升高在鉴别SSI上指示作用不明显,不应片面参考血像和体温作为延长使用抗菌药物预防SSI的绝对指征,应结合其他指标进行综合判断。OBJECTIVE To assess the prophylactic use of antibiotics of the patients with surgical site infections（SSI）and the patients without the infections after the coronary artery bypass grafting（CABG）surgery and analyze some of the clinical indicators so as to guide the reasonable use of antibiotics.METHODS The prospective and targeted monitoring was carried out for the CABG surgeries which were undertaken in 9hospitals of Beijing during 2008-2010;totally 62cases of patients with SSI were selected as the SSI group,and 124cases of patients without SSI were set as the control group.The clinical indicators such as the perioperative antibiotic prophylaxis,postoperative hemogram,and temperature were compared between the two groups.RESULTS The utilization rate of antibiotics was 100.0%in both the SSI group and the control group;the utilization rate of combined antibiotic prophylaxis was 81.42%in the SSI group,79.29%in the control group;the duration of antibiotic prophylaxis was（11.18±1.12）d in the SSI group,（10.95±0.98）d in the control group,the difference between the two groups was not statistically significant;the absolute value of WBC 24-48hafter the surgery was（18.2±0.48）in the SSI group,（17.9±0.92）in the control group;the body temperature 72hours after the surgery was（37.8± 0.86）℃in the SSI group,（38.0±0.24）℃in the control group,the difference between the two groups was not statistically significant.CONCLUSION The long term or combined use of antibiotics is not reliable for the prevention of SSI,and the elevated early WBC counts or the body temperature can not indicate the SSI significantly,which can not be one-sided used as the absolute indicators for the prevention of SSI,and it should be comprehensively diagnosed by combining other indicators.

关 键 词：冠状动脉旁路移植术 抗菌药物 手术部位感染 

分 类 号：R619.3[医药卫生—外科学]