择期开腹结直肠手术单次预防性使用抗生素的安全性与有效性

Safety and efficacy of prophylactic single antibiotics administration in selective open colorectalsurgery

目的探讨择期开腹结直肠手术单次预防性使用抗生素的安全性与有效性。方法回顾性分析2009年10月至2011年10月间在北京协和医院接受择期开腹结直肠手术的275例患者。所有患者于切皮前30～60min．单次静脉输注预防性抗生素。此后如无感染并发症则不再使用任何抗生素。根据术后手术部位感染、不明原因的抗生素治疗、肠道吻合口瘘以及远处感染的发生情况．综合判定为预防成功、预防失败或远处感染。结果275例患者术中和术后无一例发生抗生素相关的药物过敏反应。单次预防性使用抗生素预防成功率88．4％（243／275），预防失败率8．4％（23／275），远处感染9例（3．3％，9／275）。预防失败的23例中，手术部位感染13例（4．7％），术后不明原因发热使用广谱抗生素者2例（0．7％），术后发生肠道吻合口瘘8例（3．6％，8／222）。结论择期开腹结直肠手术单次预防性使用抗生素安全、有效。

Objective To investigate the safety and efficacy of prophylactic single antibiotic administration in selective open colorectal surgery. Methods Two hundred and seventy-five patients undergoing selective open colorectal surgery in the Peking Union Medical College Hospital from October 2009 to October 2011 were retrospectively reviewed. Prophylatic single antibiotic administration was used by intravenous infusion 30-60 min before incision. No antibiotics would be given after operation if there was no surgical site infection （SSI）. According to the incidence of postoperative SSI, unexplained use of antibiotics, anastomotic leakage and distant-site infection, the clinical outcome was assessed to be prophylactic success, prophylactic failure or distant-site infection, respectively. Results There was no intraoperative or postoperative antibiotics related drug anaphylaxis in all the 275 patients. By prophylactic single antibiotic administration, there were prophylactic success in 243 patients（88.4% ,243/275）, prophylactic failure in 23 （8.4%,23/275）, distant-site infection in 9 （3.3%,9/275）. In the 23 patients with failed prophylaxis, there were SSI in 13 （4.7%, 13/275） patients, postoperative use of broad-spectrum antibiotics for unexplained fever in 2 （0.7%,2/275）, postoperative anastomotic leakage in 8 （3.6%, 8/222）. Conclusion Prophylactic single antibiotic administration in selective open coloreetat surgery is safe and effective.