预防性应用抗菌药物对控制乳腺癌患者手术感染的效果及预后的影响评价  

Effect of prophylactic antimicrobial agents on surgery infection in patients with breast cancer and its influence on prognosis

作　　者：王灿[1] 江华[2] 郭琪[1] 郭伟胜[3] 洪文静[1] 吕娟[1] 

机构地区：[1]河南省中医院乳腺外科,河南郑州450053 [2]河南中医药大学基础医学院病原免疫生物学科,河南郑州450046 [3]河南省中医院肿瘤外科,河南郑州450053

出　　处：《中华医院感染学杂志》2017年第11期2573-2576,共4页Chinese Journal of Nosocomiology

摘　　要：目的观察和评价预防性应用抗菌药物对控制乳腺癌手术感染的效果,以期筛查一种更加有效合理的抗菌药物应用方案,从而在经济、安全的基础上预防控制手术感染、改善患者预后。方法选取2011年4月-2016年2月168例乳腺癌患者,采用随机数字表法将纳入的168例乳腺癌改良根治术者随机分为A组、B组、C组、D组,每组42例,A组患者未采用任何抗菌药物预防感染,B组术前单次预防性应用抗菌药物,C组术后延长用药时间,D组采用联合预防性应用抗菌药物,比较4组患者治疗效果、术后发热和切口感染率及不良事件发生率、平均住院时间、住院费用和成本-效果比。结果临床痊愈率和总有效率,B组、C组、D组均高于A组,差异有统计学意义(P<0.05);术后发热率、切口感染率,B组、C组、D组均低于A组,差异有统计学意义(P<0.05);抗菌药物不良事件发生率,B组、C组低于D组,B组低于C组,差异有统计学意义(P<0.05);住院费用,B组高于A组,差异无统计学意义,C组、D组高于A组、B组,差异有统计学意义(P<0.05);成本-效果比,B组低于A组,差异无统计学意义,但与C组和D组比较,差异有统计学意义(P<0.05)。结论对于乳腺癌手术而言,采用预防性应用抗菌药物是必要的且是有效的,尤以术前单次预防性应用抗菌药物效果更佳,是一种更可行的预防用药方案,建议优先推广采用。OBJECTIVE To observe and evaluate the effect of prophylactic antimicrobial agents on the control of surgical infections of breast cancer,in order to screen a more effective and rational antimicrobial drug application program,so as to prevent infection and improve the prognosis on the basis of economy and safety.METHODS From Apr.2011 to Feb.2016,168 patients with breast cancer were selected and randomly divided into group A,group B,group C and group D according to random number table method,with 42 cases in each group.Patients in group A did not use any antimicrobial agents to prevent infection,in group B used preoperative single prophylactic antibiotics,in group C prolonged treatment time,and in group D used combined prophylactic use of antibiotics.The effects of treatment,postoperative fever,incision infection rate,incidence of adverse events,average length of hospital stay,cost of hospitalization and cost effectiveness of the 4 groups were compared.RESULTS The clinical cure rates and total effective rates in group B,C and D were significantly higher than those in group A（P〈0.05）.The fever rates and incision infection rates in group B,C and D were lower than those in group A（P〈0.05）.The incidence of adverse events was lower in group B and group C than that in group D and in group B was significantly lower than that in group C （P〈0.05）.The cost of hospitalization was higher in group B than that in group A,but the difference was not statistically significant,and in group C and group D was significantly higher than that in group A and B（P〈0.05）.The cost-effectiveness of group B was significantly lower than that of group C and D（P〈0.05） compared with group.CONCLUSION For breast cancer surgery,the use of prophylactic antibiotics is necessary and effective,especially preoperative single prophylactic use of antimicrobial drugs is better,which is a more feasible preventive medication program,and recommended to promote the use of priority.

关 键 词：乳腺癌 手术 感染 预防 抗菌药物 

分 类 号：R978.1[医药卫生—药品]