经导管肝动脉化疗栓塞术患者围术期抗菌药物应用方案探讨

Disscusion on Antibiotics Program for Patient Underwent Transcatheter Arterial Chemoembolization during Perioperative Period

目的:为经导管肝动脉化疗栓塞术(TACE)围术期合理使用抗菌药物提供参考。方法:临床药师在充分评估1例原发性肝癌患者的病情后,查找并评价当前与TACE围术期抗菌药物给药方案相关的最佳临床证据。以"hepatocellular carcinoma""antibiotic prophylaxis""肝癌""经导管肝动脉化疗栓塞术"等为主题词,计算机检索Cochrane Library(2015年4期)、Medline(1980-2015年)、中国期刊全文数据库(1990-2015年),并对所获证据进行评价分析。结果:共筛选出与临床问题密切相关的1个系统评价/Meta分析,10个随机对照试验和2个临床指南。通过文献分析认为该患者不需要预防性使用抗菌药物。结论:采用循证医学方法,为该患者制订合理的用药方案,不仅可以促进抗菌药物的合理使用,减少细菌耐药,节约治疗费用,同时有利于引导医患双方共同承担医疗不确定性的风险。

OBJECTIVE：To provide reference for rational use of antibiotics during perioperative period of transcatheter arterial chemoembolization（TACE）. METHODS：After full evaluation of 1 cases of primary liver cancerpatient’s conditions,the optimal clinical evidences were retrieved and evaluated,which were related to antibiotics regimen during perioperative period of TACE. Us-ing“hepatocellular carcinoma”“antibiotic prophylaxis”“hepatic cancer”“TACE”as subjects,the evidence were retrieved from Co-chrane Library（issue 4,2015）,Medline（1980 to 2015）and CJFD（1990 to 2015）and then evaluated. RESULTS：1 meta-analy-sis or systematic review,10 RCTs and 2 practice guidelines were identified. This patient didn’t need to use antibiotics to prevent in-fection according to literature analysis. CONCLUSIONS：The rational treatment plan according to evidence-based medicine methods for patients can not only promote the rational use of antibiotics,reduce bacterial drug resistence and treatment cost,but also guide both doctors and patients to take the indeterminate risk of medicine.