预防性抗生素在导管室进行完全经皮穿刺主动脉覆膜支架植入术的应用  

Prophylactic antibiotics: a necessity in totally percutaneous thoracic endovascular aortic repair?

作　　者：谢年谨[1,2] 罗淞元[1,2] 薛凌[1,2] 李威[3] 谷梦楠[3] 刘媛[1,2] 黄文晖[1,2] 范瑞新[1,4] 陈纪言[1,2] 罗建方 

机构地区：[1]广东省心血管研究所 [2]广东省人民医院//广东省医学科学院心血管内科,广东广州510100 [3]南方医科大学,广东广州510515 [4]广东省人民医院//广东省医学科学院心脏大血管外科,广东广州510100

出　　处：《南方医科大学学报》2015年第4期578-582,共5页Journal of Southern Medical University

基　　金：广东省科技计划项目(2012B031800318)

摘　　要：目的研究预防性抗生素的应用是否能减少主动脉腔内修复术后感染及腔内修复术后综合征发生。方法入选从2011年9月到2012年10月接受主动脉腔内修复术并且住院资料完整患者。根据术前是否使用预防性抗生素分为预防性抗生素组(PA group)和非预防性抗生素组(non-PA group)。感染的判定由两位卫生副高级职称以上医生根据2001年中华人民共和国卫生部《医院感染诊断标准》进行,腔内修复术后综合征的诊断标准主要为排除感染的术后体温大于37.5℃。结果共入组95例患者,包括35例PA组和60例non-PA组。non-PA组一例发生感染相关的死亡,PA组一例患者出现支架近端逆撕形成Stanford A型夹层并死亡(1.67%vs 2.85%,P=1.00)。两组间术后感染发生率(5%vs 2.86%,P=1.000),住院时间(9.30±7.21 vs 10.06±5.69,P=0.094),感染相关的死亡率(1.67%vs 0%,P=1.00),术后发热发生率(70.90%vs 91.43%,P=0.20)。根据重复测量的方差分析,手术后不同时间点体温差异有统计学意义(F=19.831,P<0.001),而是否预防性应用抗生素组间差异不具有统计意义(F=0.978,P=0.326)。结论目前的数据不能证明预防性应用抗生素可以减少术后感染和腔内修复术后综合征发生率。但未使用预防性性抗生素的患者发生的术后感染可能预后更差。Objective To study the benefit of prophylactic antibiotics （PA） in totally percutaneous aortic endovascular repair （PEVAR） in the catheterization laboratory for reducing stent-graft infection and postimplantation syndrome （PIS）. Methods The clinical data were analyzed of patients undergoing thoracic endovascular aortic repairs. The patients were divided into non-PA group and PA group according to the use of prophylactic antibiotics before PEVAR. The diagnosis of infection was made by two senior physicians with reference to Hospital Acquired Infection Diagnostic Criteria Assessment released by the Ministry of Health of China. Results The 95 enrolled patients included 35 with PA and 60 without PA group, who were comparable for baseline characteristics. Infection-related deaths occurred in 1 case in non-PA group and retrograde Stanford type A dissection and death occurred in 1 case in PA group （1.67%vs 2.85%, P=1.00）. The PA and non-PA groups showed no significant difference in the incidence of postoperative infection （5%vs 2.86%, P=1.000）, hospital stay （9.30±7.21 vs 10.06±5.69, P=0.094）, infection-related mortality （1.67% vs 0%, P=1.00）, or postoperative fever （70.90% vs 91.43%, P=0.20）. The body temperature showed significant variations at different time points after procedure （F=19.831, P〈0.001） irrelevant to the use of prophylactic antibiotics （F=0.978, P=0.326）. Conclusion The current data do not support the benefit of PA in reducing postoperative infection and PIS in patients undergoing PEVAR, but the patients without PA may have worse clinical outcomes in the event of postoperative infections.

关 键 词：主动脉夹层 腔内修复 感染 腔内修复术后综合征 预防性抗生素 

分 类 号：R543.1[医药卫生—心血管疾病]