妇科患者腹腔镜术后应用抗菌药物预防感染调查  

Antibiotic prophylaxis for prevention of infections in gynecology department patients after laparoscopic surgery

作　　者：孔彩霞[1] 曹佩霞[1] 金伟蓉[1] 

机构地区：[1]常州市中医医院妇科,江苏常州213003

出　　处：《中华医院感染学杂志》2013年第21期5277-5279,共3页Chinese Journal of Nosocomiology

基　　金：江苏省卫生厅科技基金资助项目(JW-2009B-062)

摘　　要：目的研究妇科腹腔镜术后抗菌药物预防感染应用的适应证及效果,对抗菌药物的合理使用进行探讨,以期提高抗菌药物临床应用合理性。方法选择2011年1月-2013年1月362例妇科腹腔镜手术患者作为研究对象,按手术类型分为两组,腹腔镜子宫全切与次全切手术183例,设为A组(污染类手术),腹腔镜下卵巢囊肿剥出术179例设为B组(清洁手术),再按术后预防性使用抗菌药物1、3、5d与不使用抗菌药物分为Ⅰ～Ⅳ4个组,比较患者手术时间、术后退热时间、抗菌药物使用时间及术后感染率。结果污染组4个组平均手术时间比较差异无统计学意义,AⅠ、AⅡ、AⅢ3组平均抗菌药物使用时间为(0.6±0.2)、(3.0±0.0)、(5.0±0.0)d,AⅠ组平均抗菌药物使用时间明显短于其他两组,差异有统计学意义(P<0.05),但3组术后平均退热时间及感染率比较差异无统计学意义;未使用抗菌药物的BⅣ组术后平均退热时间和感染率与其他3组比较,差异无统计学意义;清洁组4个亚组平均手术时间比较差异无统计学意义。结论抗菌药物的使用应遵循《抗菌药物临床应用指导原则》,对子宫切除等污染类手术预防性使用抗菌药物可缩短发热时间,降低感染率;无菌手术可以不使用或者少使用抗菌药物,以降低医疗成本。OBJECTIVE To study the indications gynecological laparoscopic surgery and observe the for antibiotic prophylaxis in prevention of infections after effect and discuss the rationality of use of antibiotics so as to guide the reasonable clinical use of antibiotics. METHODS A total of 362 cases of patients who underwent the laparoscopic surgery in gynecology department from Jan 2011 to Jan 2013 were enrolled in the study and were divided into two groups according to the surgery types, 18a cases who underwent laparoscopic complete hysterectomy or subtotal hysterectomy were assigned as the group A （contaminated surgery）, and 179 cases who underwent laparoscopie ovarian cystectomy were set as the control group （clean surgery） ;those subjects were divided into 4 groups named as from I to IV according to the prophylactic use of different antibiotics 1, 3 ,and 5 days after the surgery, then the operation duration, postoperative fever clearance time, time of use of antimicrobial agents, and incidence of postoperative infections were observed and compared. RESULTS The difference in the operation duration between the 4 groups was not statistically significant; the mean time of use of antibiotics was （0. 6±0.2） d in the A I group, （3.0±0.0） d in the AII group, （5.0±0.0）din the AⅢ group, the mean time of use of antibiotics of the A I group was significantly shorter than that of other to groups, （P〈0.05）, but the difference in the mean time of fever clearance time or the incidence of infections between the three groups was not statistically significant, as compared with the BIV group, the differences were not statistically significant; the difference in the mean operation duration between the 4 subgroups of the cleaning group was not statistically significant. CONCLUSION The use of antimicrobial agents should follow the Guidelines for clinical use of antibiotics, the anti- bioties prophylaxis for the contaminated surgeries such as the hysterectomy may shorten the fever time and reduce the inf

关 键 词：妇科手术 腹腔镜术后 预防感染 抗菌药物 

分 类 号：R978.1[医药卫生—药品]