神经外科Ⅰ类切口围手术期使用头孢呋辛和头孢曲松预防颅内感染临床效果比较

Comparison of Clinical Efficacy Between Cefuroxime and Ceftriaxone for the Prevention of Intracranial Infection in the Perioperative Period of ClassⅠNeurosurgical Incisions

目的分析神经外科3种Ⅰ类切口手术患者预防性使用头孢呋辛和头孢曲松术后脑膜炎(PNM)的发生率,比较预防性用药的有效性和经济性。方法回顾性分析2020年7月-2021年3月于神经外科接受脊柱融合、微血管减压和听神经瘤切除手术患者的临床资料,共纳入符合标准的患者386例,其中围手术期应用头孢呋辛预防176例,为头孢呋辛组;应用头孢曲松预防210例,为头孢曲松组。比较头孢呋辛和头孢曲松用于围手术期预防的PNM发生率、住院及药品费用差异。结果头孢呋辛组和头孢曲松组PNM发生率分别为6.82%(12/176)和5.24%(11/210),差异无统计学意义(P>0.05)。对围手术期预防用药合理的病例进行亚组分析,两组PNM发生率差异无统计学意义(P>0.05)。神经外科Ⅰ类切口手术不同预防用药组总体住院时间差异无统计学意义,总体住院费用差异有统计学意义(P<0.05)。3种手术预防使用头孢呋辛组药品费用及抗菌药物费用显著低于头孢曲松组(P<0.01)。结论头孢呋辛用于神经外科Ⅰ类切口手术后脑膜炎预防效果与头孢曲松相近,并在经济性方面具有优越性。

Objective To analyze the incident rate of post-neurosurgical meningitis(PNM) after prophylactic use of cefuroxime/ceftriaxone in patients after three class Ⅰ incisions in neurosurgery department, and to compare the effectiveness and economy of prophylactic medication. Methods A retrospective analysis was performed on the clinical data of patients who underwent spinal fusion, microvascular decompression and acoustic neuroma resection surgery in neurosurgery from July 2020 to March 2021. A total of 386 cases who met the criteria were included, including 176 cases in the cefuroxime group and 210 cases in the ceftriaxone group. Differences in the incidence of PNM, hospitalization and drug expenses between cefuroxime and ceftriaxone for perioperative period prophylaxis were compared. Results The incidence of PNM in the cefuroxime group was 6.82%(12/176), and the incidence of PNM in the ceftriaxone group was 5.24%(11/210). There was no significant difference in the incidence of PNM between the two groups(P>0.05). Subgroup analysis of patients with reasonable perioperative prophylactic medication showed no significant difference in the incidence of PNM between the two groups(P>0.05). There was no difference in the overall length of hospital stay between two prophylactic drug groups, and there was statistically significant difference in total hospitalization cost(P<0.05). Among the three types of incision neurosurgery, the total cost of drugs and antibacterial drugs in the cefuroxime group was significantly lower than that in the ceftriaxone group(P<0.01). Conclusion The prophylactic effect of cefuroxime for meningitis after class Ⅰ incision surgery in neurosurgery is similar to that of ceftriaxone, and it has advantages in terms of pharmacoeconomics.