盆腔炎产妇抗菌药物短程预防剖宫产手术部位感染的分析

Short-term antibiotic prophylaxis in prevention of surgical site infections in pelvic inflammatory disease puerpera udergoing cesarean section

目的探讨盆腔炎产妇应用抗菌药物短程(<24h)和长程(>48h)预防策略对剖宫产手术部位感染控制的临床疗效,为临床最优化治疗提供理论性指导。方法选取医院妇产科2011年3月-2013年3月需行剖宫产分娩的162例盆腔炎产妇,利用不同的预防策略进行非随机分组,分别设为研究组和对照组,其中研究组80例患者,采取短程抗菌药物预防策略(<24h);对照组82例患者,采取长程抗菌药物预防策略(>48h),对比两组产妇手术部位感染、子宫内膜炎发生率、产褥病发生率、血像变化、抗菌药使用频度(DDDs)和费用、新生儿Apgar评分和新生儿感染。结果研究组与对照组的产前临床基线特征差异无统计学意义,研究组与对照组子宫内膜炎发生率、产褥病发生率及术后血像升高发生率分别为8.8%与7.3%、7.5%与6.1%、60.0%与57.3%,差异均无统计学意义;研究组与对照组新生儿Apgar评分分别为(9.87±0.55)分与(9.96±0.28)分,差异无统计学意义;两组患者均无手术部位感染及新生儿感染;研究组与对照组的抗菌药物费用分别为(15.81±10.33)元与(115.86±49.75)元,DDDs分别为1.40±0.62与9.23±3.75,两组差异均有统计学意义(P<0.05)。结论对于盆腔炎产妇,实施短程抗菌药物预防策略的临床效益更加明显,不仅能与长程预防策略具有相似的临床疗效,更能减少住院期间的经济费用。

OBJECTIVE To explore the effect of short-term （less than 24h） and long-term （more than 48 h） antibiotic prophylaxis strategy on cesarean section surgical site infection control in puerpera with pelvic inflammatory disease, to provide theoretical guidance for optimal clinical treatment. METHODS 162 patients with pelvic inflammatory disease and cesarean section collected from Mar 2011 to Mar 2013, were divided into the study group （n=80） and the control group （n：82） according to short-term antibacterial prevention strategy （less than 24h） and long-term antimicrobial prophylaxis strategy （more than 48 h） non-randomly. It was compared between two groups including the incidence of surgical site infections and postoperative endometritis, puerperal morbidity, hemogram, frequency and cost of antibiotic defined daily dose （DDDs）, neonatal Apgar score and infections. RESULTS There was no significant difference in the prenatal baseline characteristics between the study group and the control group. The incidence of postoperative endometritis, puerperal morbidity, hemogram increasing of the two groups were 8.8%, 7.5%, 60.0% and 7.3%, 6.1%, 57.3% respectively, with no significant differences; there was no significant difference between the two groups in neonatal infection Apgar score. There were no surgical site infections and neonatal infections in the two groups, with the study group （9. 87±0.55） points vs the control group （9.96 ± 0.28） points. The cost of antimicrobial drug and the DDDs of the study group and the control group were （15.81 ± 10.33）, （1.40＋0.62） and （115.86＋49.75）, （9.23＋3.75） respectively, with significant difference（P〈0.05）. CONCLUSION The short-term antibiotic prevention strategy for cesarean section in puerpera with pelvic inflammatory disease is more clinical effective, because it has similar clinical efficacy with the long-range prevention strategy, with a decreased cost during hospitalization.