先天性巨结肠患儿围术期抗菌药物应用分析

Analysis of The Perioperative Use of Antibacterials in Patients with Hirschsprung's Disease

目的:了解郑州大学第三附属医院先天性巨结肠(HD)患儿围术期抗菌药物应用情况。方法:收集我院2010年8月—2011年8月HD患儿156例,按手术方式分为Ⅰ、Ⅱ、Ⅲ组,对围术期抗菌药物应用情况进行回顾性分析。结果:HD患儿使用第2、3代头孢菌素、碳青霉烯类抗菌药物和万古霉素的构成比分别是51.2%(133/260)、16.9%(44/260)和11.9%(31/260);HD患儿平均使用抗菌药时间为(6.8±3.4)d;Ⅱ与Ⅰ组和Ⅱ与Ⅲ组患儿术后使用抗菌药物的时间比较,差异皆有统计学意义(P=0.034,P=0.042),Ⅰ与Ⅲ组患儿术后使用抗菌药物的时间比较,差异无统计学意义(P=0.712,P>0.05)。22.4%(35/156)的患儿联合使用抗菌药物,Ⅰ、Ⅱ和Ⅲ组患儿联合使用抗菌药物的比例分别为16.9%(11/65)、37.0%(17/46)和15.6%(7/45)。结论:我院部分HD手术患儿抗菌药物选择不合理、用药时间不合理,应严格执行《抗菌药物临床应用指导原则》,加强抗菌药物应用监管,提高临床合理用药水平。分期手术与经肛门Soave一期拖出根治术相比,不占优势。

OBJECTIVE： To investigate the perioperative use of antibacterials in patients with Hirschsprung＇ s disease （HD）. METHODS： The medical records of 156 HD cases enrolled from Aug. 2010 to Aug. 2011 were divided into three groups （ group Ⅰ, Ⅱ and Ⅲ ） according to type of operation. The perioperative use of antibacterials was analyzed retrospectively. RESULTS： The proportions of second and third generation cephalosporins, carbapenems and vacomycin used perioperatively in HD children were 51.2% （133/260）, 16.9% （44/260） and 11.9% （31/ 260） , respectively. The postoperative administration duration of the antibacterials was 6. 8± 3.4 days on average, showing significant differences group Ⅱ and group I and between group Ⅱ and group m （P = 0. 034, P = 0. 042 ） , however, there was no significant difference between group I and group Ⅲ （P = 0. 712, P 〉 0. 05）. The rate of combined use of antibacterials was 22.4% （35/156）. The rates of combined use of antibacterials in group Ⅰ , Ⅱ and Ⅲ were 16.9% （ 11/65）, 37% （17/46） and 15.6% （7/45）, respectively. CONCLUSION： The use of antibaeterials for the children undergoing HD surgery in our hospital was irrational in the choice and administration time of antibiotics. We must strictly abide by the Guidelines for Clinical Use of Antibacterials, strengthen the supervision and management of clinical application of antibacterials and improve rational drug use level. As compared with SOAVE transanal one stage endorectal pull-through, staging operation gains no advantage.