剖宫产预防性抗生素使用时机的干预研究

Interventional study on use time of prophylactic antibiotics for cesarean

目的：探索剖宫产预防用抗菌药物的最佳时机,为降低剖宫产后感染率,合理使用抗菌药物提供研究证据。方法：纳入138例择期剖宫产患者,随机分为试验组（A）和对照组（B）。试验组切皮前0.5~2 h静脉滴注头孢硫脒2.0g,术后6 h内再静脉滴注头孢硫脒2.0g。对照组断脐后立即给予头孢硫脒,术后6 h内再静脉滴注头孢硫脒2.0g,比较2组产妇术后并发症、对新生儿的影响的差异。结果：2组患者手术时间,术中失血量,术后6、12、24、48 h体温,术后48 h白细胞、中性粒细胞,差异没有统计学意义。对照组夹闭脐带后静脉滴注头孢硫脒,抗菌药物预防时间短于试验组,P〈0.05,2组患者比较有统计学意义,但没有显示出对产妇/新生儿的影响。2组出院时均无一例发生子宫内膜炎、伤口感染、症状性尿路感染,出院后随访2周和6周也未发现患者再次感染。试验期间,5例产妇发生产褥病率,2例在试验组,3例在对照组,差异无统计学意义。NICU立即入院率、新生儿败血症发生率、新生儿败血症标本送检率,差异没有统计学意义。新生儿大便菌群失调主要表现为Ⅰ、Ⅲ度,但经统计学处理,没有显著性差异。结论：仅依据本中心的数据,足月孕择期剖宫产,不合并胎盘早剥、胎膜早破、前置胎盘等感染风险因素,未显示出预防用抗菌药物时机对产妇/新生儿的影响。

OBJECTIVE To investigate optimal time of perioperative antibiotics for cesarean section to reduce maternal/neonatal infectious morbidity,and provide evidences for rational use of antimicrobial agents.METHODS A total of 138 pregnant women were recruited and randomly allocated to two equal groups.Women in treatment group（group A）received 2 g of intravenous cefathiamidine prior to skin incision while those in control group（group B）received the drug immediately after cord clamping.Each woman received 2 g of intravenous cefathiamidine within 6h after cesarean section.Following outcome parameters were measured including maternal endometritis,wound infection,urinary tract infection,maternal postpartum fever,neonatal sepsis,submission of neonatal sepsis sample,NICU admission,and neonatal intestinal dysbacteriosis.Maternal postoperative temperature was monitored within 6,12,24 and 48 hours.Simultaneously,counts of leucocyte and neutrophil were tested within 48 h.RESULTS In 10 months,112 women received elective cesarean delivery were enrolled,57 in group A and 55 in group B.The most reason for cesarean was request from the patient.No significant difference was observed in baseline demographic characteristics between groups.During operation,estimated blood loss,maternal postoperative temperature within6,12,24 and 48 hours,and counts of leucocyte and neutrophil within48 h were similar between groups.No woman had endometritis,wound infection or urinary tract infection,and no infection occurred during follow up of 2 weeks and 6 weeks after discharge.However,two and three women had maternal postpartum fever in group A and B,respectively.No significant difference was observed in neonatal sepsis,submission of neonatal sepsis sample or NICU admission.Neonatal intestinal dysbacteriosis was mainly gradeⅠ and Ⅲ.CONCLUSION Prophylactic antibiotic administration prior to surgery or after cord clamping is probably of equal effects in reducing postoperative maternal infections after cesarean section,and shows no influence on mothers/neonates.