厄他培南预防直肠癌高危手术部位感染的临床疗效分析  

Efficacy of ertapenem in the prevention of high-risk surgical site infection in rectal cancer surgery

作　　者：刘准 王枭杰[1] 孙艳武[1] 黄胜辉[1] 唐子涵 陈锦华 池畔[1] 黄颖[1] Zhun Liu;Xiaojie Wang;Yanwu Sun;Shenghui Huang;Zihan Tang;Jinhua Chen;Pan Chi;Ying Huang(Department of Colorectal Surgery,Fujian Medical University Union Hospital,Fuzhou 350000,China;Follow-up Center of Medical Department,Fujian Medical University Union Hospital,Fuzhou 350000,China)

机构地区：[1]福建医科大学附属协和医院结直肠外科,福州350000 [2]福建医科大学附属协和医院医务部随访中心,福州350000

出　　处：《中华结直肠疾病电子杂志》2022年第6期497-505,共9页Chinese Journal of Colorectal Diseases(Electronic Edition)

基　　金：福建省科技创新联合资金项目(2020Y9071);福建省自然科学基金(2020J01130);北京医卫建康公益基金会医学科学研究基金(B2006DS);福建省卫生健康科技计划项目(2020CXA025);白求恩公益基金(BCF-SY-0311-20190807-08)。

摘　　要：目的探讨厄他培南预防直肠癌术后手术部位感染的临床疗效及其影响因素分析。方法选取2010年3月到2022年3月在福建医科大学附属协和医院结直肠外科术前应用抗生素预防手术部位感染的直肠癌患者775例;通过倾向性评分匹配(PSM)后,共纳入230例术前应用抗生素预防手术部位感染的直肠癌患者,厄他培南组46例、非厄他培南组184例,对比厄他培南组和非厄他培南组预防直肠癌手术部位感染的疗效;采用Logistic回归单、多因素分析直肠癌手术部位感染的危险因素。结果厄他培南组患者表浅手术部位感染发生率低于非厄他培南组(8.7%vs.22.3%,P=0.038);单因素分析发现厄他培南(OR=4.317,P=0.038)、手术方式(P=0.0001)、肿瘤距离肛缘的距离(OR=0.718,P=0.011)、手术时间(OR=1.010,P=0.002)与直肠癌术后表浅手术部位感染密切相关;多因素分析结果表明:非厄他培南(OR=4.392,95%CI:1.325~14.564;P=0.016)、手术方式(APR手术,OR=25.65,95%CI:2.960~222.37;P=0.003)、手术时间(OR=1.011,95%CI:0.003~1.019;P=0.004)是直肠癌术后表浅手术部位感染的独立危险因素。结论厄他培南比非厄他培南组更有效预防直肠癌表浅手术部位感染,APR手术和手术时间长的直肠癌患者应积极应用厄他培南预防手术部位感染。Objective To investigate the effect of ertapenem in preventing surgical site infection(SSI)of rectal cancer(RC)surgery.Methods From March 2010 to March 2022,a total of 775 RC patients who received perioperative prophylaxis with antibiotics to prevent SSI in Fujian Medical University Union Hospital were collected.After propensity score matching,230 RC patients were enrolled in the ertapenem group(46 cases)and the non-ertapenem group(184 cases).The efficacy of prevention of SSI in the ertapenem and non-ertapenem groups was compared using following propensity score matching(PSM).Risk factors of SSI in RC surgery were analyzed by univariate and multivariate Logistic regression anlaysis.Results The incidence of SSI in the ertapenem group was significantly lower than that in the non-ertapenem group(8.7%vs.22.3%,P=0.038).Univariate analysis found ertapenem(OR=4.317,P=0.038),operation method(P=0.0001)distance from the anal verge to the tumor(OR=0.718,P=0.011)and operation time(OR=1.010,P=0.002)were closely related to SSI.Multivariate analysis revealed that non-ertapenem(OR=4.392,95%CI:1.325~14.564;P=0.016),abdominoperineal resection(APR)surgery(OR=25.65;95%CI:2.960~222.37;P=0.003)and operation time(OR=1.011,95%CI:0.003~1.019;P=0.004)were independent risk factors of SSI.Conclusion Ertapenem can effectively prevent SSI in rectal cancer surgery.RC patients with APR surgery and long operation time are candidates that should receive ertapenem for the prevention of SSI.

关 键 词：直肠肿瘤 手术部位感染 预防用药 厄他培南 

分 类 号：R735.37[医药卫生—肿瘤]