宫腔镜手术预防性使用抗菌药物的随机对照研究

Antibiotics prevention for operative hysteroscopy:A randomized controlled clinical trial

目的分析宫腔镜手术期间预防性使用抗菌药物后预防术后感染的效果,并评估临床必要性。方法选取2019年1~12月深圳市南山区妇幼保健院收治的90例患者(诊断为子宫内膜息肉、黏膜下肌瘤或子宫内膜增生)作为研究对象,采用随机分配法分为非抗菌素组(49例)和抗菌素组(41例)。非抗菌素组在行宫腔镜检查术前不用抗菌药物,抗菌素组在宫腔镜检查术前30 min使用抗菌药物。比较两组术后主要指标(术后发热、感染和疼痛的情况)和次要指标(抗菌药物引发的过敏反应、腹胀、头晕、头痛、腹泻、呕吐以及恶心等不良反应)。结果两组患者术后主要指标的发热情况和疼痛发生率比较,差异无统计学意义(P>0.05)。两组患者术后均无感染、子宫出血、盆腔炎、盆腔脓肿、宫颈炎/阴道炎和子宫内膜炎发生。抗菌素组有2例患者出现过敏反应。两组患者术后次要指标腹胀、头晕、头痛、腹泻、呕吐、恶心等不良反应发生率的比较,差异无统计学意义(P>0.05)。结论预防性使用抗菌药物不能降低宫腔镜术后的感染发生率,在做好围术期管理和遵循医院感染管理制度的情况下,临床中对于低风险患者可以考虑不用抗菌药物。

Objective To explore the effect of prophylactic use of antimicrobial agents during hysteroscopy to prevent postoperative infection and to evaluate the clinical necessity.Methods A total of 90 patients(diagnosed as endometrial polyp,submucous myoma or endometrial hyperplasia)admitted to Nanshan Maternity&Child Healthcare Hospital of Shenzhen from January to December 2019 were selected as the research objects and divided into the non-antibacterial group(49 cases)and the antimicrobial group(41 cases)according to the random allocation method.Non-antibacterial group did not use antimicrobial agents before hysteroscopy,and the antimicrobial group used antibiotics at 30 min before hysteroscopy.The primary postoperative indicators(post-operative fever,infection and pain)and secondary postoperative indicators(antimicrobial-induced allergic reactions,abdominal distension,dizziness,headache,diarrhea,vomiting,and adverse reactions such as nausea)were compared between the two groups.Results There were no significant differences in the incidence rates of fever and pain in major postoperative indicators between the two groups(P>0.05).There were no infection,uterine bleeding,pelvic inflammatory disease,pelvic abscess,cervicitis/vaginitis and endometritis occurring in both groups.Anaphylaxis occurred in 2 patients of the antimicrobial group.There were no significant differences in the incidence rates of abdominal distension,dizziness,headache,diarrhea,vomiting,nausea and other adverse reactions between the two groups(P>0.05).Conclusion Preventive use of antimicrobial agents can not reduce the incidence of infection after hysteroscopy.Under the condition of perioperative management and following the management system of nosocomial infection,antimicrobial agents can be considered for low-risk patients.