抗生素使用方式对择期剖宫产患者生殖道菌群及临床结局的影响

Effects of Preoperative Antibiotic Therapy on Micro Ecosystem in Genital Tract of Patients with Elective Caesarean Section

目的 探讨抗生素不同使用方式对择期剖宫产患者生殖道菌群及临床结局的影响。方法 60例择期剖宫产患者随机分成三组各20例,A组,手术前后均不使用抗生素;B组,手术后常规使用抗生素3d;C组,于手术中常规应用抗生素1次。每例分别在术前、术后3d术后7d行阴道液、宫腔液细菌培养,观察手术前后生殖道菌群变化,并记录患者体温、白细胞计数、晚期产后出血情况。结果 患者手术前阴道细菌培养阳性率为34.58％,手术后为76.26％(P<0.05);手术中胎盘娩出后宫腔物培养均为阴性。A组手术前后3d及7d阴道内液培养仍以厌氧菌为主;而B、C两组手术后3d、7d阴液培养则以需氧菌为主;三组宫腔内细菌培养阳性率接近;术后产褥病率三组相近;未发生晚期产后出血。结论 剖宫产术中及手术后应用抗生素易使患者出现菌群失调,剖宫产术后应合理使用抗生素。

Objective To investigate the effects of different antibiotic treatments on clinical outcomes and bacterial flora in genital tract of patients with elective caesarean section. Methods The study included 60 cases who were divided into 3 groups at random: group A no antibiotic administration, group B postoperative antibiotic treatment for 3 days and group C intraoperative antibiotic transfusion for one time. Bacterial cultures of vaginal secretion and uterine cavity secretion were performed preoperatively and at day 3 and day 7 after operation. At the same time, body temperature, leukocyte count and vaginal bleeding in late postpartum were documented. Results Positive culture rate of vaginal secretion was 34.58% before operation, and 76.26% after operation(P<0.05) and all culture results of uterine cavity secretion were negative. For group A, anaerobe was common in vaginal secretion at day 3 and 7 post operation, while that was aerobe in group B and C. Positive culture rate of uterine cavity secretion and puerperal morbidity were similar in 3 groups and no late postpartum hemorrhage occurred. Conclusion Intraoperative and postoperative antibiotic administration may cause upset of bacterial flora in patients with elective caesarean section, so sensible postoperative antibiotic therapy should be recommended.