妇科清洁手术患者围术期预防用抗菌药物指征的探讨

Indications of perioperative antibiotics prophylaxis for patients undergoing gynecological aseptic surgeries

目的探讨妇科清洁手术患者围术期预防用抗菌药物的指征,为规范妇科清洁手术患者围术期预防用药提供参考。方法选取医院2013年3月-2015年2月全部妇科清洁手术病例(剔除手术前已诊断感染的病例)1 057例,采用回顾性调查及电话回访相结合的方法,按是否合并其他情况分为未合并其他情况和合并其他情况包括:(年龄≥65岁、手术持续时间≥3h、盆腔积血或术中出血>1500ml、糖尿病、手术部位≥2个、盆腔粘连、慢性盆腔炎和阴道炎治疗后)两个组,对比分析不同人群预防用抗菌药物和未预防用抗菌药物患者手术部位感染(SSI)的情况。结果 1 057例妇科清洁手术患者SSI率为0.76%,其中未合并其他情况组397例,SSI率0.50%;合并其他情况组660例,SSI率0.91%;未合并其他情况组:未预防用抗菌药物患者SSI率0.68%,预防用抗菌药物患者SSI率0.40%,差异无统计学意义;合并其他情况组:未预防用抗菌药物患者SSI率0.85%,预防用抗菌药物患者SSI率0.98%,差异无统计学意义。结论未合并其他情况的妇科清洁手术患者围术期通常不需预防用抗菌药物;合并其他情况的妇科清洁手术患者围术期抗菌药物预防效果有限,术前对合并其他情况进行积极干预和纠正治疗,全面落实预防SSI的综合措施更为重要。

OBJECTIVE To explore the indications for perioperative antibiotics prophylaxis for patients undergoing gynecological aseptic surgeries so as to provide guidance for standardizing the antibiotics prophylaxis during perioperative periods of gynecological aseptic surgeries.METHODS A total of 1 057 patients who underwent the gynecological aseptic surgeries（excluding the cases of infections diagnosed before surgeries）from Mar 2013 to Feb 2015 were enrolled in the study.By means of retrospective surgery combined with call-back,the enrolled patients were divided into the with other factors group and the without other factors group according to the status of complication with other factors（no less than 65 years of age,operation duration no less than 3hours,volume of hemoperitoneum or intraoperative blood loss more than 1500 ml,diabetes,no less than 2of surgical sites,pelvic adhesion,after treatment of chronic pelvic inflammation and vaginitis）.The incidence of surgical sites infection（SSI）was observed and compared between the patients who were treated with antibiotics prophylaxis and those who were not.RESULTS The incidence rate of SSI was 0.76% among the 1 057 patients undergoing the gynecological surgeries,0.50% among the 397 patients in the without other factors groups,0.91% among the 660 patients in the with other factors group.In the without other factors group,the incidence rate of SSI was 0.68%in the patients who were not treated with antibiotics prophylaxis,0.40%in the patients who were treated with antibiotics prophylaxis,and there was no significant difference.In the with other factors group,the incidence rate of SSI was 0.85%in the patients who were not treated with antibiotics prophylaxis,0.98%in the patients who were treated with antibiotics prophylaxis,and three was no significant difference.CONCLUSION The gynecological aseptic surgery patients without complication of other factors usually do not need the antibiotics prophylaxis during the perioperative period,the perioperative antibiotics prophylaxis has little effect on the gynecological aseptic surgery patients with complication of other factors.It is crucial to actively take interventions and conduct the corrective treatment before the surgeries as well as fully implement the comprehensive prevention measures of SSI.