结肠直肠外科中的抗菌病因预防(英文)

ANTIBIOTIC PROPHYLAXIS IN COLORECTAL SURGERY

抗菌病因预防对成功的外科手术是一种辅助措施,但并不能取代它.在任何研究中,评价某一抗菌方案有效性时,应考虑多种可变因素,诸如手术技能差异、护理和手术室成员的差异、患者自身的抵抗力以及疾病的严重程度等. 对研究成果之评价,以下两点应予以重视:(1)明确并发症的定义;(2)评价应与手术者无关. Keighley 等使用头孢三嗪噻肟(一种长效头孢菌素)和灭滴灵在结肠手术中作单剂量病因预防.该项研究基本满足上述标准. 在上述研究中.“将120名施行结肠手术的患者随机分配到头孢三嗪噻肟(2g) 和灭滴灵(1.5g)组(59例)或庆大霉素(150mg)和灭滴灵(1.5g)组(61例).在手术室,通过单剂量静脉给药对他们进行抗菌病预防.接受头孢三嗪噻肟和灭滴灵治疗组的腹部伤口脓毒症发生率为8.5%,而庆大霉素加灭满灵组达23%(p<0.05).就手术而言,经过选择的(干净未被污染)与有并发疾患(不干净已被污染)者之间伤口脓毒发生率无差异”.未发生败血症,但两种方案未能阻止腹腔内脓肿形成,因此,每组有四人发生脓肿. 对入院病人进行连续序贯观察,术前静脉给予头孢三嗪噻肟(2g) 和灭满灵(0.5),未见伤口感染、腹腔脓肿或败血症等. 此种独特的病因预防表明,在结肠直肠外科手术中作单剂量病因预防是安全的.

Antibiotic prophylaxisis supplementary to good surgical tech-nique and not a replacement for it. A varia-tion in surgical skill, standards or nursingand operating room staff, and variations inthe patients'own resistance or illness severi-ty provide a multitude of variable factorsin any study assessing the usefulness of aparticular antibiotic regime. In determining results of studies, it isimportant that definitions of complicationsbe established, and that assessment of pa-tients be done independently of the opera-tors. The study by Keighley et al of cef-triaxone (a long acting cephalosporin )with metronidazole as a single doseprophylaxis in colorectal surgery fulfilledthe majority of the above criteria. In that study, '120 patients undergoingcolorectal surgery were randomly allocatedto ceftriaxone (2g) and metronidazole(1.5g) (59 patients) or gentamicin (120mg)and metronidazole (1,5mg) (61 patients) assingle dose intravenous prophyiaxis in theoperating theatre. The overall rate of ab-dominal wound sepsis was 8.5%in thegroup receiving ceftriaxone andmetronidazole compared with 23% in thegentamicin plus Metronidazole group (p<0.05). There was no difference in the rate ofwound sepsis according to whether opera-tions were elective (clean contaminated) orfor complicated disease (contaminated anddirty).' There were no episodes ofsepticaemia, but neither regime preventedthe formation or intra-abdominal abscess,which occurred in four patients or eachgroup. In a consecutive personal series of pa-tients using the Ceftriaxone 2g andmetronidazole 0.5g intravenously at thecommencement of surgery, there were nowound infections, intra-abdominal abscessor episodes of septicaemia. This particular method of prophylaxisdemonstrates the safety of single doseprophylaxis in colorectal surgery.