人工髋关节置换术预防性抗生素应用时机的临床研究

Clinical study of occasio for antibiotic prophylaxis in hip arthroplasty surgery

[目的]探讨人工髋关节置换术前抗感染预防性应用抗生素的最佳时机。[方法]全髋关节置换90例,选用氨苄青霉素(UNS)和头孢呋辛(CXM)作预防性用药,分别设术前1 d、术前1 h或手术开始后30 m in 3个时段静脉滴注,每组15例。采集手术开始时周围静脉血、处理髋臼时骨质渗血、处理股骨髓腔时髓腔出血以及手术结束时引流管引流血,采用微量稀释法作血清杀菌活性(SBAs)测定,比较不同给药时间、不同时段术野出血的抗菌效能。[结果]UNS和CXM对临床常见致病菌的SBA接近。术前1 h给药,UNS和CXM在手术开始至处理髋臼时SBA≥1:8的百分率较大(P<0.05);术始30 m in给药,UNS在磨削髋臼至处理股骨髓腔时、CXM在处理股骨髓腔至手术结束时SBA≥1:8百分率大于其它时段(P<0.05)。[结论]术前1 h至手术开始后静脉应用抗生素可在髋关节假体植入的主要阶段保持较高的术野血抗菌效能,从而有可能进一步减少术后感染的机会。但是不同抗生素的应用时机还应根据其药代动力学的差异进行相应调整。

[Objective] To study the best time for infusing antibiotics as prophylaxis against infection in hip arthroplasty. [ Method] Ninty cases of hip arthroplasty were divided into 6 groups randomly with 15 cases each. Ampicillin （UNASYN, 1.5g） and cefuroxime axetil （Zinacef, 2.0g） was administered by intravenous infusion respectively one day or one hour before operation or 30 minutes after the operation began. Blood samples from peripheral vein, cancellous bone of acetabulum when reaming, medullary canal of femur when rasping and catheter fight after the operation were harvested. Serum Bactericidal Activities （SBAs） were determined by minim dilution technique and were compared between the groups. [ Result] SBAs of UNASYN and Zinacef are similar to the bacteria most commonly causing infection after prosthesis implantation such as staphylococcus. Percentage at SBA≥ 1：8 of UNASYN and Zinacef is significantly more at the beginning of operation and when reaming acetabulum than the other groups （ P 〈 0.05 ） if they are administered one hour before operation. Percentage at SBA 〉/1：8 of UNASYN when it is administered 30 minutes after the operation began is more when reaming acetabulum and rasping medullary canal than the other stages （ P 〈0.05）. But percentage at SBA≥ 1：8 of Zinacef when it is administered 30 minutes after the operation began is more when rasping medullary canal and at the end of operation than the other stages （P 〈 0.05 ）. [ Conclusion ] Application of antibiotics by intravenous infusion one hour before operation or at the beginning of operation can usually maintain a relatively high level of bactericidal activities of blood in the operation area at the main stage of implants insertion and this may further decrease the opportunity of postoperative infection. But this should be adjusted according to the kinetics of different antibiotics.