老年腹胆镜胆囊切除术围术期抗菌药应用临床分析

Clinical analysis of antibiotics used in perioperative laparoscopic cholecystectomy for elderly patients

目的回顾性分析老年腹胆镜胆囊切除术(LC)围术期抗菌药的应用。方法 2009年1月—2012年6月因慢性胆囊炎胆结石在西京医院行LC的老年患者200例中男110例,女90例,年龄60～79(69.2±10.5)岁。将200例患者分为抗菌药组100例和对照组100例。抗菌药组于术中取胆汁做细菌培养及药物敏感试验,LC前30 min静脉注射头孢呋辛钠,术后预防性使用青霉素等抗菌药3 d。如果术中发现胆囊炎性反应较重,则术后静脉给予甲硝唑,头孢哌酮等抗菌药4 d;对照组手术患者未使用抗菌药。每例患者门诊或电话随访1个月,观察术后感染及并发症发生情况,同时于术前和术后1周进行血生化指标测定。结果抗菌药组发生术后感染并发症者3例(3.0%),包括切口感染2例和尿路感染1例;对照组发生术后感染并发症者12例(12.0%),包括切口感染8例,肺部感染4例,抗菌药组感染发生率明显低于对照组(P<0.05)。治疗后两组ALT和总胆红素(TBIL)均显著下降(P<0.01),但两组间无统计学差异(P>0.05)。结论在老年LC围术期合理使用抗菌药可减少感染发生率。

Objective To retrospectively analyze the perioperative antibacterial drug application to elderly patients undergoing lapa- roscopic cholecystectomy （LC）. Methods A total of 200 elderly patients with chronic choleeystitis or gallstones [ 110 males, 90 females; aged 60 -69 （69.2 ＋ 10.5） yeas], who underwent LC in Xijing Hospital from January 2009 to June 2012, were divided into antimicrobial drug group （rt = 100 ） and control group （n = 100 ）. In the antimicrobial drug group, the bile was intraoperatively taken for bacterial culture and drug sensitivity test. Cefuroxime sodium was administered intravenously 30 minutes earlier before LC. Penicillin and other antibacterial drugs were prophylactically used for three days after surgery. If sever inflammatory response due to choleeystitis was found intraoperatively, postoperative intravenous use of Metronidazole, Cefoperazone and other antibiotics ：were performed for four days. As for the control group, the antibiotics were not applied to the patients. Every patient was followed up via sick call or telephone after operation for one month. Blood biochemical parameters were measured one week before and after opera- tion. Results In the antibacterial drug group, postoperative infection complication occurred in 3 cases （3.0%）, including 2 cases of wound infection and 1 case of urinary tract infection; and in the control group the complication occurred in 12 cases （ 12.0% ）, including 8 cases wound infection and 4 cases lung infection. The incidence of infection was significantly lower in the antimicrobial drug group than in the control group （ P 〈 0.05 ）. After treatment, alanine aminotransferase and total bilirubin decreased significant- ly in both the two groups（ P 〈 0.01 ） , but there existed no statistically, significant difference between the two groups （P 〉 0.05 ）.Conclusion It is showed that the perioperative rational use of antibiotics !n elderly patients undergoing LC helps to reduce the inci- dence of infection.