老年人腹腔镜胆囊切除术预防性使用抗生素的对比研究  

Prophylactic antibiotics us in elderly patients undergoing laparoscopic cholecystectomy

作　　者：田之豪 颜喆 王吉祥 黄傲 罗轩明 周俭 TIAN Zhihao;YAN Zhe;WANG Jixiang;HUANG Ao;LUO Xuanming;ZHOU Jian(Department of Liver Surgery,Research Institute of Liver Cancer,Zhongshan Hospital,Fudan University,Shanghai 200032,China;Department of General Surgery,Xuhui District Central Hospital,Xuhui Hospital of Zhongshan Hospital,Fudan University,Shanghai 200031,China)

机构地区：[1]复旦大学附属中山医院肝脏外科肝癌研究所,上海200032 [2]上海市徐汇区中心医院,复旦大学附属中山医院徐汇医院普外科,上海200031

出　　处：《同济大学学报（医学版）》2023年第3期406-410,共5页Journal of Tongji University(Medical Science)

基　　金：上海市科学技术委员会项目(19511121303);上海市卫生健康委员会项目(201940389);上海市徐汇区中心医院院级课题(XHYY2020);上海市徐汇区医学科研项目(SHXH202104)。

摘　　要：目的针对老年患者(年龄>70岁)行腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)预防性使用抗生素的对比研究。方法上海市徐汇区中心医院2020年7月—2021年7月行LC术的老年患者(年龄>70岁)67例分为预防性使用抗生素组(antibiotic group,AG)和未预防性使用抗生素组(non-antibiotic group,NAG)。回顾性分析两组患者年龄、手术时间、白细胞计数(white blood cell counts,WBC)、C-反应蛋白(C-reactive protein,CRP)、降钙素原(procalcitonin,PCT)及切口感染等指标的差异,两组患者根据术后发热情况(体温≥38℃)再分为发热组和体温正常组,比较两组患者年龄、性别等临床指标。结果两组术前WBC、CRP、PCT差异无统计学意义(P>0.05);术后第1天WBC、CRP、PCT水平较术前均有变化,差异有统计学意义(P<0.05);NAG组术后第1天WBC、PCT水平显著高于AG组,差异有统计学意义(P<0.05),但两组术后第1天CRP值比较差异无统计学意义(P>0.05);AG组与NAG组术后切口感染分别为1例(2.56%)和2例(7.14%),差异无统计学意义(P>0.05);两组患者均未发生腹腔感染、器官感染、全身感染及抗生素相关性腹泻;AG组与NAG组发生术后体温≥38℃的患者分别为3例(7.69%)和5例(17.86%),差异有统计学意义(P<0.05);术后比较发热组与体温正常组在年龄、BMI、手术时间、手术方式(三孔法/四孔法)、术中是否放置引流管、是否合并糖尿病等方面差异无统计学意义(P>0.05),发热组术中胆汁培养阳性率显著高于正常组,差异有统计学意义(P<0.05)。结论对于机体情况良好、符合纳入标准的老年(>70岁)患者,不使用预防性抗生素是安全、有效的。Objective To investigate the efficacy of prophylactic use of antibiotics in elderly patients(age>70 years)undergoing laparoscopic cholecystectomy(LC).Methods Clinical data of 67 patients undergoing LC in Shanghai Xuhui District Central Hospital group from July 2020 to July 2021 were retrospectively analyzed,including 39 cases receiving prophylactic antibiotics(PA group),and 28 cases did not receive prophylactic antibiotics(NPA group).The general information,operation time,white blood cell counts(WBC),C-reactive protein(CRP),procalcitonin(PCT)and surgical incision infection were compared between the two groups.The factors influencing postoperative fever were analyzed.Results There were no significant differences in preoperative WBC,CRP and PCT between the two groups(P>0.05).The levels of WBC,CRP and PCT on the first day after operation were higher than those before operation in both groups(P<0.05);the levels of WBC and PCT in NPA group were significantly higher than those in PA group on the first day after operation(P<0.05),but not for CRP(P>0.05).There were 1 case(2.56%)and 2 cases(7.14%)of superficial incision infection in AG group and NAG group,respectively(P>0.05).There were no deep incision infection,organ infection,systemic infection and antibiotic related diarrhea in both groups.The number of cases with postoperative body temperature≥38℃in PA group and NPA group were 3 cases(7.69%)and 5 cases(17.86%)respectively(P<0.05).There were no significant differences in age,BMI,operative time,operative method(three hole method or four hole method),placement of drainage tube or comorbid diabetes(P>0.05)between patients with postoperative fever and those without fever(P>0.05);however the positive rate of bile bacteria culture was significantly higher in the fever group than that in non-fever group(P<0.05).Conclusion The results indicate that it is not necessary to use prophylactic antibiotics during elective laparoscopic cholecystectomy in elderly patients who meet the inclusion criteria.

关 键 词：老年患者 腹腔镜胆囊切除术 预防性 抗生素 

分 类 号：R605[医药卫生—外科学]