术前应用抗生素预防经口内镜下肌切开术感染的临床效果

Effects of perioperative antibiotics on infection after peroral endoscopic myotomy: a prospective randomized controlled trial

目的 探讨术前应用抗生素预防经口内镜下肌切开术(POEM)术后感染的临床效果。方法 前瞻性地连续选择2012年6月至2012年9月在我院消化内镜中心行POEM术患者20例,并随机分为抗生素组和对照组。20例患者均成功完成POEM术,且满足纳入和排除标准。抗生素组术9例术前0.5～1h给予静脉滴注头孢曲松钠2.0g,对照组11例则给予等量的0.9%氯化钠溶液静脉滴注。密切监测患者术后感染相关并发症发生及实验室指标变化情况。结果 20例患者于术后第1天白细胞计数、中性粒细胞比例、C反应蛋白量及体温,较术前均明显升高(P<0.01),术后第3天时基本恢复正常。两组术后均无出现感染及体温明显升高现象。相比之下,两组白细胞计数及中性粒细胞在术前1天,术后1、3、7天的变化趋势不同(P<0.05),且对照组在白细胞计数,中性粒细胞方面升高较抗生素组更明显(P<0.05)。而两组在体温及C反应蛋白变化趋势及升高情况方面差异并不显著(P>0.05)。结论 良好的术前准备和仔细的手术操作对预防POEM术后感染是十分重要的。在此基础上,术前应用抗生素对其并无明显的临床意义。但其最终结论尚需大样本进一步研究。

Objective To investigate clinical effects of preoperative antibiotics on infection afterperoral endoscopic myotomy ( POEM ) for achalasia. Methods This was a prospective randomizedcontrolled trial.Data for 20 patients who underwent POEM between June 2012 and September 2012 wasanalysed.POEM were finished successfully and all the patients followed inclusion criteria and exclusioncriteria.Patients in preoperative antibiotics group were administered intravenous ceftriaxone sodium 30 -60 min before operation and control group for equivalent normal saline. Complications,especially infection,were given close observation,as well as change of laboratory index.Results There was a significantincrease in leucocyte count,CRP (C reactive protein),neutrophil ratio and body temperature on the firstday postoperatively ( P < 0.01 ),which then recovered to the normal level on the third day postoperatively.No infection-related complications were encountered,including significant temperature increase ( T >38.0℃ ).By contrast,the change tendency of leucocyte count and neutrophil ratio at 1 day pre-operationand 1,3,7day post-operation was of significant difference between two groups P < 0.05 ),while that of CRPand temperature had a slight difference ( P > 0.05 ).Additionally,leucocyte count and neutrophil ratio ofcontrol group increased more obviously than that of antibiotics group at 1 day pre-operation (P<0.05).Conclusions It suggestedthat preoperative administration of antibiotics offered no clinical benefits in the prevention of infection after POEM if well preoperativepreparation and careful operation were performed.Meantime, study on a large scale are still awaited to reach the final conclusion.