腹腔镜胆囊切除术围手术期抗生素的应用研究

The research of antibiotics used in perioperative of laparoscopic cholecystectomy

目的探讨腹腔镜胆囊切除术围手术期抗生素的应用。方法选择腹腔镜胆囊切除术患者200例,随机分为A组(100例)和B组(100例)。A组于术中取胆汁细菌培养并作药物敏感试验,胆囊切除手术前30min静脉注射头孢呋辛钠(商品名:达力欣)1.5g,术后预防性使用青霉素等抗生素3d。如果术中发现胆囊炎性反应较重,则术中静脉滴注0.5%甲硝唑100ml,术后联合使用头孢哌酮(先锋必)等抗生素4d。B组手术前后均不使用抗生素。每例患者通过临床观察,门诊或电话随访,观察其术后1个月感染性并发症的发生率。结果A组发生感染并发症3例(3.00%),分别为戳孔感染2例,尿路感染1例;B组发生感染的并发症12例(12.00%),分别为戳孔8例,肺部感染4例,2组感染发生率差异有统计学意义(P<0.05)。结论腹腔镜胆囊切除围手术期使用抗生素可以减少感染的发生率,值得临床应用。

Objective Laparoscopic cholecystectomy to be explored perioperative application of antibiotics. Methods Choice 200 cases of patients with laparoscopic chotecystectomy were randomly divided into group A（ 100 cases） and group B （100 cases）, lntraoperative get bacteria in bile to nurture and to do drug sensitivity test of group A, 30 minutes before cholecystectomy intravenous injected cefuroxime sodium （trade name：Dali-yan） 1.5g, after preventive used such as penicillin antibiotics 3 days. If found cholecystitis was heavier, intraoperative 0.5 % metronidazole 100ml intravenous drip, after the operation used antibiotics such as cefoperazone （Pioneer bismuth） for 4 days. Group B didn＇t use antibiotics. To observed the incidence of infectious complications after one month by clinical observation ,outpatient or telephone follow-up of each patient. Results A group of three cases of occurrence of infectious complications （3.00%）, stamp holes were two cases of infection, urinary tract infection in one case;The group B infection occurred in 12 cases （12.00%） ,8 cases of stamp-hole,4 cases of pulmonary infection. Difference in infection rate of these two groups was statistically significant （ P 〈 0.05 ）. Conclusion Laparoscopic cholecystectomy perioperative used antibiotics could reduced the incidence of infection.