不同手术阶段应用抗菌药物预防结直肠癌手术患者切口感染的对照研究

A comparative study on the effects of using antibacterial agents at different stages of surgery to prevent incision infection in patients with colorectal cancer and observation on pathogen distribution

目的 探讨不同手术阶段应用抗菌药物预防结直肠癌手术患者切口感染的效果,并观察病原菌分布特征以期为临床合理干预提供依据.方法 前瞻性选取2017年1月到2018年2月大同市第五人民医院收治的直肠癌手术患者99例.所有入选患者在手术治疗的过程中均应用抗菌药物预防切口感染,采用随机数字表法将其分为三组,其中观察组33例患者在麻醉诱导期即术前0.5～1.0 h应用抗菌药物,对照A组33例患者在术前1～2 d开始应用抗菌药物,对照B组33例患者在术后0.5～1.0 h应用抗菌药物.统计并比较三组术后切口感染发生率,利用多因素回归分析影响术后切口感染发生率的相关因素.记录病原菌分布特征.结果 观察组切口感染发生率（9.09％）低于对照A组（30.30％）、对照B组（33.33％）,P〈0.05.感染独立危险因素分析结果显示,肥胖、腹腔镜手术、手术时间、术后造瘘以及糖尿病是造成直肠癌患者术后切口感染的主要因素（P〈0.05）.病原学检测结果显示,99例患者中共24例发生感染,发生率为24.24％,共分离出病原菌标本27株,其中革兰阴性菌检出率最高（66.67％）,其次为革兰阳性菌（25.93％）.结论 在麻醉诱导期采取抗菌药物干预可取得良好的感染预防效果,针对感染危险因素如肥胖、腹腔镜手术、手术时间、术后造瘘以及糖尿病等应采取针对性预防措施.

Objective To investigate the effects of using antibacterial agents at different stages of operation on the incision infection prevention for patients with colorectal cancer , and to provide evidence for reasonable interventions in clinic by observing the distribution characteristics of pathogenic bacteria .Methods A total of 99 patients who underwent rectal cancer operation in Datong Fifth People＇s Hospital from January 2017 to February 2018 were prospectively selected for investigation .All the patients were treated with antibiotics to prevent incision infection during the surgical treatment .Enrolled patients were divided into three groups by random number table method . Thirty-three patients in observation group were given antibiotics with in 0.5 to 1.0 h prior to anesthesia induction , 33 patients in control group A were given antibiotics at 1 to 2 d before treatment , 33 patients in control group B were given antibiotics within 0.5 to 1.0 h after operation .The incidence of postoperative incision infection was compared among the three groups , and the related factors of incidence of postoperative incision infection were analyzed by multivariate regression analysis .The characteristics of the distribution of pathogenic bacteria were recorded .Results The incidence of incision infection in observation group （9.09%） was significantly lower than that in control group A （30.30%） and control group B （33.33%）,P〈0.05. Analysis on independent risk factors of infection showed that obesity , laparoscopic surgery , operation time, postoperative fistula and diabetes mellitus were the major causes of postoperative incision infection in patients with rectal cancer （ P〈0.05 ） .Etiological detection results showed that there were 24 cases of infection among 99 patients , with the incidence of 24.24%, and a total of 27 cases of pathogenic bacteria were isolated, of which the detection rate of Gram-negative bacteria was the highest （66.67%）, followed by Gram-positive bacteria （ 25.93%） .Conclusions The antibiotics intervention can achieve good infection prevention effect during anesthesia induction . Prevention measures should be implemented against infection risk factors such as obesity , laparoscopic surgery , operation time , postoperative fistula , and diabetes, specially.