子宫切除术围术期抗生素应用的探讨

Prophylactic Application of Antibiotics during Perioperative Period in Patients Undergoing Hysterectomy

目的探讨子宫切除术围术期预防性应用抗生素不同用药方法预防术后感染的效果。方法将160例因各种子宫良性病变而行经腹子宫全切除术患者按用药方法分为4组,每组40例。A组:术前24 h初次给药,术后用药3 d;B组:术前30 min初次给药,术后用药3 d;C组:术后用药3 d;D组:术后用药5 d。药物均选用甲硝唑与头孢噻肟钠。结果术后最高体温B组低于A、C、D组(P<0.05),术后退热时间B组较A、C、D组短(P<0.05),术后病率B组较A、C、D组显著降低(P<0.05),术后感染(均为腹部切口感染)率,B组均低于A、C、D组(P<0.05)。A、C、D组间各指标比较差异均无统计学意义(均P>0.05)。术后不良反应各组间比较差异无统计学意义(均P>0.05)。结论子宫切除术前30 min使用抗生素较术前24 h使用抗生素更有效、合理,术后抗生素应用时间多于3 d与3 d以内相比不能降低感染率。

Objective To investigate the efficacy of different administration schedule of antibiotics during perioperative period in the prevention of postoperative infection in patients undergoing hysterectomy.Methods A total of 160 patients who underwent abdominal total hysterectomy for benign uterine disease were divided into four groups.The metronidazole and cefotaxime sodium were given 24 hours before operation and 3 days after operation in group A,30 minutes before operation and 3 days after operation in group B,3 days after operation in group C,and 5 days after operation in group D.Results Compared with group B,the highest temperature,antifebrile time,morbidity rates and incision infection rates significantly increased after operation in group A,C and D（P0.05）,but there were no significant differences among the three groups（P0.05）.In addition,no obvious differences in postope-rative adverse events were found among the four groups（P0.05）.Conclusion The usage of antibiotics at 30 minutes before hysterectomy is more effective and rational than that at 24 hours before hysterectomy.And antibiotics used for more than 3 days can not decrease infection rates compared with those used for less than 3 days.