术前及术后使用抗菌药物对凶险性前置胎盘剖宫产后炎性因子及新生儿胆红素水平影响

Effect of preoperative and postoperative use of antibacterial drugs on inflammatory factors and neonatal bilirubin levels after caesarean section for dangerous placenta previa

目的 探讨术前及术后使用抗菌药物对凶险性前置胎盘剖宫产后炎性因子及新生儿胆红素水平影响。方法 选取2016年1月30日至2020年6月30日于我院接受剖宫产的120例凶险性前置胎盘孕产妇,根据随机数表法分为3组(A组、B组、C组),各40例。3组患者均接受头孢呋辛钠预防感染,A组于术前30min注射,B组于术前30min开始注射直至术后第3天,C组于术后开始注射,持续至术后第3天。观察3组手术指标、手术前后炎症因子水平、术后产妇感染情况及伤口愈合情况、并发症发生情况、新生儿胆红素血症发生率。结果 3组患者手术时间、术中出血量、术中输血量、术中子宫切除率差异无统计学意义(P>0.05),C组术后住院时间长于A、B组,差异有统计学意义(P<0.05)。3组患者术前CRP、TNF-α、IFN-γ、IL-6间差异无统计学意义(P>0.05),C组术后CRP、TNF-α、IFN-γ、IL-6水平高于A、B组,差异有统计学意义(P<0.05)。3组伤口甲级愈合、乙级愈合率无统计学意义(P>0.05),C组最高体温、白细胞水平高于A、B组,差异有统计学意义(P<0.05),B组白细胞水平高于A组,差异有统计学意义(P>0.05)。3组患者术后热病、宫腔感染、产褥感染、切口感染、泌尿系统感染发生率差异无统计学意义(P>0.05),C组感染总发生率、新生儿胆红素血症发生率高于A、B组,差异有统计学意义(P<0.05)。结论 术前30min使用抗生素对感染预防能力高于术后使用抗生素,且炎症反应小,住院时间短,新生儿胆红素血症发生率低。

Objective To investigate the effect of preoperative and postoperative use of antimicrobials on inflammatory factors and neonatal bilirubin levels after caesarean section for dangerous placenta previa.Methods A total of 120 pregnant women with dangerous placenta previa who received cesarean section in our hospital from January 30,2016 to June 30,2020 were selected and divided into 3 groups(group A,group B,group C)according to the random number table method.Group),each with 40 cases.Three groups of patients received cefuroxime sodium to prevent infection.Group A was injected 30 minutes before surgery,Group B started injection 30 minutes before surgery until the 3rd day after surgery,Group C started injection after surgery and lasted until the 3rd day after surgery.Observed the three groups of surgical indicators,levels of inflammatory factors before and after the operation,postoperative maternal infection and wound healing,the occurrence of complications,and the incidence of neonatal bilirubinemia.Results There was no significant difference in the operation time,intraoperative blood loss,intraoperative blood transfusion,and intraoperative hysterectomy rate among the three groups(P>0.05).The postoperative hospital stay in group C was longer than that in groups A and B,and the difference was statistically significant.(P<0.05).There was no significant difference in CRP,TNF-α,IFN-γ,and IL-6 between the 3 groups before operation(P>0.05),and the levels of CRP,TNF-α,IFN-γ,and IL-6 in group C were higher after operation The difference between groups A and B was statistically significant(P<0.05).The wound healing rates of grade A and grade B in the three groups were not statistically significant(P>0.05).The highest body temperature and white blood cell level in group C were higher than those in groups A and B,and the difference was statistically significant(P<0.05).The white blood cell level in group B Higher than A group,the difference is statistically significant(P>0.05).There was no significant difference in the incidence of postoperative fever,uterine cavity infection,puerperal infection,incision infection,and urinary system infection among the three groups(P>0.05).The total incidence of infection in group C and the incidence of neonatal bilirubinemia were not statistically significant.The rate was higher than that of groups A and B,and the difference was statistically significant(P<0.05).Conclusion The use of antibiotics 30 minutes before surgery has higher infection prevention ability than postoperative antibiotics,and the inflammatory response is small,the hospital stay is short,and the incidence of neonatal bilirubinemia is low.