食管癌患者围手术期抗菌药物选用与术后肺部感染的相关性研究

Study on correlation of perioperative prophylactic antibiotic use and pulmonary infection after esophageal cancer surgery

目的探讨食管癌患者围手术期抗菌药物的选用与术后肺部感染的相关性,为临床合理用药提供参考。方法收集2012年4-11月医院284例食管癌手术患者临床资料,包括手术方式、美国麻醉师协会评分等数据,详细记录手术预防用抗菌药物的名称、剂量、初始给药及追加时间、手术持续时间等,使用SPSS 21.0统计软件进行单变量及多变量分析。结果 284例患者术后发生肺部感染68例,感染率23.94%;肺部感染患者痰标本分离出革兰阴性菌29株占96.67%,革兰阳性菌1株占3.33%;术前给药时机正确的有258例,占90.84%;210例患者手术持续时间>3h,仅146例追加使用了抗菌药物;68例肺部感染患者使用第一代头孢菌素,患者使用第一、二代头孢菌素或头孢曲松及β-内酰胺酶抑制剂复方制剂后,肺部感染发生率分别为27.23%和17.20%,术前给药时机对术后肺部感染发生有显著影响,术中追加与否对术后肺部感染发生无显著影响。结论食管癌患者围手术期抗菌药物的选择对术后肺部感染并无影响,应严格遵循相关指南推荐用药。

OBJECTIVE To investigate the correlation of perioperative prophylactic antibiotic use and pulmonary infection after esophageal cancer surgery so as to provide reference for clinical rational drug use .METHODS The clinical data of 284 patients undergoing esophageal cancer surgery during Apr . to Nov .2012 were collected , including types of surgery and American Society of Anesthesiologists scores .The name of antibiotics ,dosage , initial administration and supplementation time ,and operation duration were also documented . The univariate analysis and the multivariate analysis were conducted using the software SPSS 21 .0 .RESULTS Postoperative pulmonary infections occurred in 68 of the 284 patients with the infection rate of 23 .94% .Totally 29 strains of gram negative bacteria （96 .67% ） and 1 strain of gram positive bacteria （3 .33% ） were isolated from sputum specimens of infected patients . There were 258 patients （90 .84% ） with correct preoperative administration timing ,210 patients with operation duration longer than 3 hours and only 146 patients had additive antibacterial agents .First‐generation cephalosporins were intravenously used for pulmonary infections in 68 patients . The pulmonary infection rate was 27 .23% after administration of first‐and second‐generation cephalosporins and was 17 .20% after administration of ceftriaxone and β‐ lactamase inhibiting compounds .Significant association was observed in antibiotic timing with postoperative pulmonary infections , however no significant association was observed in supplement dosage with postoperative pulmonary infections .CONCLUSION There was no correlation of perioperative antibiotic choices and postoperative pulmonary infections .It is necessary to select drugs in accordance with recommendations in related guidelines .