体外膜肺氧合预防性使用抗生素的调查分析  

The current situation of prophylactic use of antibiotics in patients undergoing ECMO

作　　者：崔晓磊[1] 樊登云 吕宝谱 刘亮[1] 肖浩[1] 张睿[1] 郑拓康 田英平[1] 姚冬奇[1] 孙艺青 高恒波[1] CUI Xiaolei;FAN Dengyun;LV Baopu(Emergency Department,The Second Hospital of Hebei Medical University,Hebei,Shijiazhuang 050000,China)

机构地区：[1]河北医科大学第二医院急诊科,石家庄市050000

出　　处：《河北医药》2022年第7期1101-1103,1107,共4页Hebei Medical Journal

摘　　要：目的了解体外膜肺氧合(extracorporeal membrane oxygenation,ECMO)预防性使用抗生素的现状。方法以互联网调查问卷的方式对全国多家三级医院进行调查,内容包括静脉-动脉体外膜肺氧合(veno-arteria ECMO,VA-ECMO)是否预防性使用抗生素、体外心肺复苏(extracorporeal cardiopulmonary resuscitation,ECPR)是否预防性使用抗生素、预防性使用何种抗生素等。结果共收集调查问卷40份,其中三级甲等医院39家,三级乙等医院1家,涵盖15个省,2个直辖市,1个自治区。大多数医院目前置管方式选择穿刺置管,非手术室上机VA-ECMO患者、ECPR患者多数医院选择预防性使用抗生素,抗生素多为第二代头孢菌素或者第三代头孢菌素,29家预防性使用抗生素的医院中选择联合使用糖肽类抗生素9家,多数选择万古霉素。VA-ECMO未预防性使用抗生素,之后7 d内加用抗生素的占多数。VA-ECMO预防性使用抗生素,之后7 d内再升级的主要原因与肺部感染相关,少数选择血流感染。结论目前多数医院VA-ECMO选择预防性使用抗生素,抗生素种类没有统一标准,需要进一步大规模临床研究,探索预防性使用抗生素是否有效,进而规范相关治疗。Objective To investigate the current situation of prophylactic use of antibiotics in patients undergoing extracorporeal membrane oxygenation(ECMO).Methods By means of an Internet questionnaire,several tertiary hospitals were investigated for the data including the application status of veno-arteria ECMO(VA-ECMO),prophylactic use of antibiotics during extracorporeal cardiopulmonary resuscitation(ECPR),and what kind of antibiotics being used.Results A total of 40 questionnaires were collected,in whci,39 cases were from the gradeⅢ,class A hospital and 1 case from gradeⅢ,class B hospital,covering 15 provinces,2 municipalities directly under the central government and 1 autonomous region.At present,most hospitals chose puncture catheterization,and most hospitals chose prophylactic antibiotics for patients with VA-ECMO or ECPR in non-operating room,and most antibiotics were second-generation cephalosporins or third-generation cephalosporins,of the 29 hospitals that used prophylactic antibiotics,9 hospitals used glycopeptide antibiotics,with the majority using vancomycin.VA-ECMO did not take antibiotics prophylactically,and the majority of patients took antibiotics within 7 days.VA-ECMO prophylactic use of antibiotics,followed by strengthening use within 7 days due to lung infections.Conclusion At present,most hospitals in VA-ECMO choose to use antibiotics prophylactically,and there is no uniform standard of the kinds of antibiotics,therefore,it necessary to perform large-scale clinical research to explore the efficacy of prophylactics,so as to carry out standardized treatment.

关 键 词：体外膜肺氧合 预防性使用抗生素 肺部感染 血流感染 

分 类 号：R978.1[医药卫生—药品]