血管内介入治疗围手术期预防性使用抗生素的临床意义

Clinical significance of antibiotic prophylaxis in perioperative period of intravascular interventional therapy

目的:探讨血管内介入治疗在围手术期应用抗生素对术后感染的预防价值。方法:回顾性分析我院2007年1月至2013年3月收治的肝癌行肝动脉化疗栓塞术(transcatheter arterial chemoembolization,TACE)患者资料以及2011年1月至2013年3月收治的肝硬化行经颈静脉肝内门体分流术(transjugular intrahepatic portosystemic shunt,TIPS)患者资料。纳入TACE共计538例,包括男501例,女37例,年龄(52.87±12.33)岁,TIPS术共计61例,包括男47例,女14例,年龄(47.52±9.55)岁。根据TACE和TIPS围手术期是否预防性应用抗生素,将病例分为预防性使用抗生素组和未预防性使用抗生素组,比较2组术后感染率,并分析术后感染相关危险因素。结果:TACE术预防性使用抗生素组术后感染率为16.71%(60/359),未预防性使用抗生素组术后感染率为20.11%(36/179)(P=0.33)。单因素及多因素分析提示肝功能Child-Pugh分级、手术时间大于2 h为术后感染的独立影响因素。TIPS预防性使用抗生素组术后感染率为33.33%(5/15),未预防性使用抗生素组术后感染率为34.78%(16/46)(P=0.92)。多因素分析提示年龄、肝功能Child-Pugh分级为TIPS术后感染的独立影响因素。结论:肝功能Child-Pugh A级患者TACE及TIPS围手术期不必常规预防性使用抗生素,对于肝功能差、手术时间长、老年等高危感染因素患者,酌情选择适宜的抗生素更有临床预防价值。

Objective ：To investigate the protective effect of antibiotic prophylaxis against postoperative infection in perioperative peri- od of intravascular interventional therapy. Methods：Clinical data of inpatients with liver cancer undergoing transarterial chemoem- bolization（TACE） from January 2007 to March 2013 or inpatients with cirrhosis undergoing transjugularintrahepatic portosystemic shunts （TIPS） from January 2011 to March 2013 were collected and retrospectively analyzed. There were 538 patients undergoing TACE, including 501 males and 37 females,with an average age of （52.87 ± 12.33）-year-old. There were 61 patients undergoing TIPS including 47 males and 14 females, with an average age of （47.52 ± 9.55）-year-old. According to antibiotic prophylaxis in periopera- tive period of TACE and TIPS, inpatients were classified into TACE antibiotic prophylaxis treatment group,TACE non antibiotic pro- phylaxis treatment group ,TIPS antibiotic prophylaxis treatment group and TIPS non antibiotic prophylaxis treatment group. Postopera- tive infection rate and risk factors of infection were analyzed and compared. Results： The postoperative infection rate of TACE antibi- otic prophylaxis treatment group and TACE non antibiotic prophylaxis treatment group were 16.71% （60/359） and 20.11% （36/179） respectively（P=0.33）. Univariate and multivariate analyses indicated that Child-Pugh score and operation time over 2 h were indepen- dent risk factors. The postoperative infection rate of TIPS antibiotic prophylaxis treatment group was 33.55（5/15） and that of TIPS non antibiotic prophylaxis treatment group was 34.78 （16/46）（P=0.92）. Multivariate analysis showed that age and Child-Pugh score were independent risk factors. Conclusion：Antibiotic prophylaxis in patients with Child-Pugh A undergoing TACE or TIPS therapy is not routinely necessary. However, it is more reasonable to use appropriate antibiotics for the high-risk group who have poor liver func- tion, long operation time and advanced age.