冠心病介入治疗患者围术期炎症标识物变化分析

Perioperative changes of inflammatory markers in patients undergoing coronary intervention

目的:研究冠心病介入治疗患者围手术期感染标识物的变化,观察有无感染发生,指导术前抗菌药物的应用。方法:将238例行冠心病介入的患者随机分为对照组与观察组,每组119例,观察组在介入检查及治疗时不使用任何抗菌药物,对照组在术前0.5~2 h使用头孢唑啉1.0 g静脉滴注,对头孢过敏者改用克林霉素0.6 g静脉滴注。检测2组患者术前1 d及术后48 h的血清降钙素原(PCT)、C-反应蛋白(CRP)浓度和白细胞计数(WBC),观察术后发热、感染发生情况及PCT、WBC升高例数。结果:2组术前与术后PCT和CRP浓度及WBC比较无显著性差异(P>0.05),术后2组间也无显著性差异(P>0.05)。2组术后48 h内发热、感染发生率、PCT和WBC升高例数无显著性差异(P>0.05)。结论:冠心病介入治疗操作不导致感染标识物的升高,术前不预防性使用抗菌药物并不增加感染发生,严格的无菌操作才是预防感染的关键。

Objective： To study the perioperative changes of inflammatory markers in patients undergoing coronary intervention so as to provide a guidance for clinical reasonable use of antibiotics. Methods： 238 patients undergoing coronary intervention were randomly divided into observation group and control group,119 cases in each group. The observation group was not given any antibiotics during interventional examination and treatment while the control group was treated with 1. 0 g cefazolin intravenous drip or 0. 6 g clindamycin intravenous drip for those allergic to cefazolin between 30 minutes to 2 hours before operation. The serum procalcitonin（ PCT）,C-reactive protein（ CRP） and white blood cell（ WBC） were detected a day before operation and 48 hours after operation. The postoperative fever,infection incidence,cases of increased PCT and WBC were observed and compared between the two groups. Results： After operation,PCT,CRP and WBC had no significant changes compared with those before operation in two groups,and there were no significant differences in PCT,CRP and WBC between the two groups after operation（ P 〉 0. 05）. There were no statistically significant differences in postoperative fever,infection incidence and cases of increased PCT and WBC（ P 〉 0. 05）. Conclusion： Coronary intervention treatment for coronary heart disease does not lead to the increase of infection markers,and prophylactic disuse of antibiotics does not increase the occurrence of infection. Strict aseptic operation is the key to prevent infection.