腹膜透析置管术预防性抗生素用药的前瞻性随机对照临床研究

Prospective randomized controlled trial of antibiotic prophylaxis for newly placed peritoneal dialysis catheter to prevent postoperative peritonitis and wound infection

目的比较新置腹膜透析管患者预防性抗生素用药的疗效,为国内腹膜透析置管术预防性使用抗生素的时机、途径和种类的共识提供依据。方法选择腹膜透析的患者78例,其中男性33例,女性45例,平均年龄(48．2±15．7)岁。进行为期1年的前瞻性随机对照临床研究。患者被随机分为两组,每组39例。A组：在腹膜透析置管术前30 min静脉注射头孢曲松1．0 g。B组：在术后3 d内使用0．25 g/L头孢唑啉的腹透液。术后每日检查患者伤口情况,记录体温,检查血白细胞计数和分类情况及透出液常规。结果两组患者在置管术后10 d内,都没有发生手术切口感染、隧道感染及腹膜炎。A组39例中有1例出现出口处感染,占2．5%；B组39例中有2例出现出口处感染,占5．1%,两组间差异无统计学意义。两组患者术后体温、血白WBC数及分类、透出液WBC胞计数均在正常范围,两组间差异没有统计学意义。结论在新置腹膜透析管患者伤口感染和腹膜炎的发生率方面,术前一次性给予抗生素的方式与传统的术后腹腔内给予抗生素方式差异无统计学意义,但前者在临床使用上更为简便。

Objective To assess the efficacy of two antibiotic prophylactic regimens in a prospective randomized trial in 1 year for patients undergoing insertion of catheters, and to provide the evidence for uniform consensus existing on the timing, route, and choice of antibiotic. Methods During a period of 12 months, 78 patients, who consecutively entered the peritoneal dialysis programme, [45 women and 33 men, mean age （48.2±15.7）years] were included. The prophylactic regimens were a single dose of ceftriaxone （1.0 g） given intravenously 30 minutes before surgery （Group A） and given cefazolin （0.25 g/L） i.p. in the each dialysis bag for 3 days postoperatively （Group B）. All operations were performed in one room. The wound was observed every day, and body temperature, Count of white blood corpuscle and type, dialysate were examined every day. Results In Group A and B, none of the patients showed peritonitis or wound infection during the post-operative period （within 10 days）. One of 39 patients（2.5%） in the group A, and 2 of 39 patients （5.1%） in the group B had exit site infection （P 〉 0.05）. Conclusions There is no significant difference in the incidence of peritonitis and wound infection between two groups. Prophylactic preoperative single-dose antibiotics intravenously do as well as antibiotics given intraperitoneally for peritoneal dialysis catheter insertion, but is much more convenient.