论旋动式与负压式人工流产术前预防性使用抗菌药物的临床价值

Clinical Value of Prophylactic Use of Antibiotics Before Rotating and Negative Pressure Induced Abortion

目的:探讨旋动式与负压式人工流产术前预防性使用抗菌药物的临床价值。方法:选取2018年4月~2020年11月在本院自愿行人工流产术的患者310例作为研究对象,采用随机数字表法分为旋动式组(n=155)和负压式组(n=155);在此基础上再分为旋动式预防组(n=77)和旋动式不预防组(n=78)、负压式预防组(n=77)和负压式不预防组(n=78)。旋动式预防组和负压式预防组患者术前1 h予静脉注射头孢呋辛钠,旋动式不预防组和负压式不预防组术前不给予预防性使用抗菌药物。观察所有患者术中出血量、手术时间、术后阴道流血时间、月经复潮时间、术后并发症(腹痛、发热、不完全流产、感染、宫颈宫腔粘连等)。结果:4组术中出血量、术后阴道流血时间、月经复潮时间及术后并发症发生率比较具有统计学差异(P<0.05)。其中,负压式不预防组术中出血量多于负压式预防组(P<0.05)、术后阴道流血时间长于负压式预防组(P<0.05),且术后并发症发生率高于负压式预防组(P<0.05);旋动式预防组和旋动式不预防组各指标比较无统计学差异(P>0.05)。负压式组术中出血量多于旋动式组(P<0.05),术后阴道流血时间、术后复潮时间长于旋动式组(P<0.05),且术后并发症发生率高于旋动式组(P<0.05)。结论:为有效减少人工流产术中出血量、缩短术后流血时间和降低并发症发生率,负压式人工流产术需要术前预防性使用抗菌药物,而旋动式人工流产术无需术前预防性使用抗菌药物;对于术前无细菌感染的患者,建议优先选择旋动式人工流产术;若选择负压式人工流产术,可在术前合理使用抗菌药物。

Objective:To explore the clinical value of prophylactic use of antibiotics before rotation and negative pressure induced abortion.Methods:310 cases of spontaneous abortion in our hospital from April 2018 to November 2020 were selected as the research subjects.They were divided into rotation group(n=155)and negative pressure group(n=155)by using random number table method.The rotation group and negative pressure group were then divided into rotation prevention group(n=77)and rotation non prevention group(n=78),negative pressure prevention group(n=77)and negative pressure non prevention group(n=78).One hour before operation,cefuroxime sodium was injected intravenously in the rotation prevention group and the negative pressure prevention group,while antibiotics were not used in the rotary nonprevention group and the negative pressurenon prevention group.The amount of bleeding,operation time,vaginal bleeding time,menstruation time,postoperative complications(abdominal pain,fever,incomplete abortion,infection,cervical intrauterine adhesions,etc.)were observed.Results:There were significant differences among the four groups in the amount of intraoperative bleeding,the time of postoperative vaginal bleeding,the time of menstrual recovery and the incidence of postoperative complications(P<0.05).Among them,the amount of intraoperative bleeding in the negative pressure non prevention group was significantly higher than that in the negative pressure prevention group(P<0.05),and the time of postoperative vaginal bleeding was significantly longer than that in the negative pressure prevention group(P<0.05),and the incidence of postoperative complications was significantly higher than that in negative pressure prevention group(P<0.05).There was no significant difference between the indexes of rotation prevention group and rotation non prevention group(P>0.05).The amount of bleeding in the negative pressure group was significantly higher than that in the rotation group(P<0.05),and the time of postoperative vaginal bleeding and postoperative tide recovery was significantly longer than that in the rotation group(P<0.05),and the incidence of postoperative complications was significantly higher than that in the rotation group(P<0.05).Conclusion:In order to effectively reduce the amount of bleeding,shorten the bleeding time and reduce the incidence of complications,the negative pressure type needs to use prophylactic antibiotics before operation,while the rotating type does not need prophylactic antibiotics before operation.For the patients without bacterial infection before operation,it is suggested that rotation abortion should be preferred.If negative pressure abortion is selected,antibiotics can be used reasonably before operation.