头孢菌素联合吗啉硝唑预防肠外瘘手术部位感染的临床价值

Clinical value of cephalosporin combined with morinidazole in the prevention of surgical site infection for gastrointestinal fistula

目的探讨头孢菌素联合吗啉硝唑预防肠外瘘病人手术部位感染(SSI)的临床价值。方法采用回顾性队列研究方法。收集2017年1―12月中国人民解放军东部战区总医院收治的107例行择期消化道重建手术肠外瘘病人的临床病理资料;男76例,女31例;中位年龄为46岁,年龄范围为18~79岁。107例病人中,43例病人给予头孢菌素预防SSI,设为头孢菌素单药组;64例病人给予头孢菌素联合吗啉硝唑预防SSI,设为联合用药组。观察指标:(1)SSI发生情况。(2)分层分析。(3)SSI致病菌培养结果。(4)药物不良反应发生情况。(5)随访情况。采用门诊和电话方式进行随访,了解病人其他并发症发生情况。正态分布的计量资料以x±s表示,组间比较采用独立样本t检验;偏态分布的计量资料以M(范围)表示,组间比较采用Mann⁃Whitney U检验。计数资料以绝对数或百分比表示,组间比较采用χ^(2)检验或Fisher确切概率法。结果(1)SSI发生情况:107例病人中,29例发生SSI,其中浅层切口感染15例、深层切口感染7例、器官和(或)腔隙感染7例。头孢菌素单药组病人发生总体SSI、浅层切口感染、深层切口感染、器官和(或)腔隙感染的例数分别为18、7、5、6例,联合用药组上述指标分别为11、8、2、1例,两组病人总体SSI比较,差异有统计学意义(χ^(2)=7.925,P<0.05)。两组病人器官和(或)腔隙感染比较,差异有统计学意义(P<0.05)。两组病人浅层切口感染比较,差异无统计学意义(χ^(2)=0.305,P>0.05)。两组病人深层切口感染比较,差异无统计学意义(P>0.05)。(2)分层分析:43例头孢菌素单药组病人中,Ⅱ类切口10例、Ⅲ类切口33例;64例联合用药组病人中,上述指标分别为11、53例。在Ⅱ类切口中,头孢菌素单药组病人发生SSI 1例,联合用药组2例,两组比较,差异无统计学意义(P>0.05)。在Ⅲ类切口中,头孢菌素单药组病人发生SSI 17例,联合用药组9例,两组比较,差异有统计学意(χ^(2)=11.499,P<0.05)。(3)SSI致病菌培养结果:29例发生SSI病人中,细菌培养阳性21例,其中单一细菌感染12例,多种细菌混合感染9例,共培养出33株细菌。(4)药物不良反应发生情况:107例病人均未见药物相关不良反应发生。(5)随访情况:107例病人均获得随访,随访时间为术后30 d。所有病人未见其他并发症。结论头孢菌素联合吗啉硝唑可用于预防肠外瘘病人SSI。

Objective To investigate the clinical value of cephalosporin combined with morinidazole in the prevention of surgical site infection(SSI)for gastrointestinal fistula.Methods The retrospective cohort study was conducted.The clinicopathological data of 107 patients with gastrointestinal fistula who undergoing selective digestive tract reconstruction surgery in General Hospital of Eastern Theater Command from January to December 2017 were collected.There were 76 males and 31 females,aged from 18 to 79 years,with a median age of 46 years.Of 107 patients,43 cases receiving cephalosporin for prevention of SSI were allocated into cephalosporin monotherapy group,64 cases receiving cephalosporin combined with morinidazole were allocated into combination therapy group,respectively.Observation indicators:(1)incidence of SSI;(2)stratification;(3)pathogen culture results of SSI;(4)adverse drug reaction;(5)follow-up.Follow-up using outpatient examination and telephone interview was performed to detect other complications of patients.Measurement data with normal distribution were represented as Mean±SD,and comparison between groups was analyzed using the independent sample t test.Measurement data with skewed distribution were represented as M(range),and comparison between groups was analyzed using the Mann-Whitney U test.Count data were described as absolute numbers or percentages,and comparison between groups was analyzed using the chi-square test or Fisher exact probability.Results(1)Incidence of SSI:29 of 107 patients had postoperative SSI,including 15 cases with superficial SSI,7 cases with deep SSI,and 7 cases with organ/space SSI.There were 18 cases of cephalosporin monotherapy group with SSI,including 7 cases with superficial SSI,5 cases with deep SSI,and 6 cases with organ/space SSI.The above indicators were 11,8,2,1 of combination therapy group,respectively.There was a significant difference in the overall SSI between the two groups(χ2=7.925,P<0.05).There was also a significant difference in the organ/space SSI between the two groups(P<0.05).There was no significant difference in the superficial SSI between the two groups(χ2=0.305,P>0.05).There was no significant difference in the deep SSI between the two groups(P>0.05).(2)Stratification:there were 10 cases and 33 cases with typeⅡincision and typeⅢincision in the 43 cases of cephalosporin monotherapy therapy group,respectively.The above indicators were 11 and 53 in the combination group,respectively.For the typeⅡincision,1 patient of cephalosporin monotherapy group had SSI,and 2 cases of combination therapy group had SSI,showing no significant difference between the two groups(P>0.05).For the typeⅢincision,17 patient of cephalosporin monotherapy group had SSI,and 9 cases of combination therapy group had SSI,showing a significant difference between the two groups(χ2=11.499,P<0.05).(3)Pathogen culture results of SSI:of 29 patients with SSI,21 were positive for bacterial culture,including 12 cases with single bacterial infection,9 cases with mixed infection of multibacteria.A total of 33 strains were cultured.(4)Adverse drug reaction:there was no adverse drug reaction in the 107 patients.(5)Follow-up:107 patients were followed up for 30 days after surgery.No complication occurred in the 107 patients.Conclusion Cephalosporin combined with morinidazole can be used to prevent the SSI for patients with gastrointestinal fistula.