不同抗生素用药方案在预防腹膜透析置管术后腹膜炎中的比较

The importance of antibiotic prophylaxis for preventing postoperative peritonitis in patients after catheterization for peritoneal dialysis

目的比较不同预防性用药方案在新置腹膜透析导管患者的使用情况,探讨抗生素用药在预防新置腹膜透析导管患者术后发生腹膜炎的重要性。方法回顾性分析2008年10月至2012年10月在北京大学深圳医院肾内科腹膜透析中心接受腹膜透析置管术开始行腹膜透析治疗的患者173例。按照预防性使用抗生素方法分为3组,A组:患者在腹膜透析置管术后3天内使用含有头孢唑啉0.25g/L的腹透液,共计101例次;B组:患者在腹膜透析置管术前3h静脉滴注头孢唑林0.5g,共计48例次;C组:患者术前及术后3天均未使用抗生素,共计24例次。比较3组患者术后14天内腹膜炎的发生率。结果 A组101例患者中1例出现腹膜炎,发生在术后第11天,占0.99%;B组48例患者中2例出现腹膜炎,均发生在术后第1天,占4.17%;C组24例患者中4例出现腹膜炎,3例发生在术后第1天,1例发生在术后第2天,占16.67%。对3组患者腹膜炎发生率进行两两比较,A组与C组比较,P=0.005,P<0.01,差异有统计学意义;B组与C组比较,P>0.05,差异无统计学意义;A组与B组比较,P>0.05,差异无统计学意义。结论腹膜透析置管术围手术期预防性抗生素用药十分有必要,术后腹腔内给药或术前一次静脉用药能有效预防术后腹膜炎发生。

Objective To evaluate the efficiency of two antibiotic prophylaxis regimens in our peritoneal dialysis center. Methods We retrospectively analyzed 173 patients undergoing catheterization for peritoneal dialysis from October 2008 to October 2012. Patients were divided into 3 groups, 0.25g/L cefazolin in dialy- sate for 3 days after the surgery （group A）, a single dose of 0.5g cefazolin given intravenously 3 hours before the surgery （Group B）, and no antibiotics administration before the operation and within 3 days after the oper- ation （group C）. They were observed for peritonitis after the operation for 14 days. Results One of the 101 pa- tients （0.99%） in group A, 2 of the 48 patients （4.17%） in group B, and 4 of the 24 patients （16.67%） in group C were found to have peritonitis within 14 days after the operation. The incidence of peritonitis was sig- nificantly different between group A and group C （P=0.005, P〈0.01）, but was indifferent between group A and group B, and between group B and group C. Cone I us i on Antibiotics prophylaxis during catheterization for peritoneal dialysis is essential to prevent postoperative peritonitis. Intraperitoneal cefazolin administration after the operation for 3 days or a single dose cefazolin intravenously before the operation can effectively re- duce the incidence of postoperative peritonitis.