抗菌药物短程预防策略控制盆腔炎产妇剖宫产手术部位感染的效果评价

摘要

评价围手术期短程(＜24 h)抗菌药物使用策略预防盆腔炎产妇剖宫产后手术部位感染的效果.方法:选择于我院接受剖宫产术后存在盆腔炎的产妇227例,将患者按预防方式分为短程(＜24 h)组109例和长程(＞48h)组118例.对2组患者产妇孕程、体质量指数、住院前时间、术前白细胞数,是否初产、胎膜早破、妊娠高血压综合征(妊高征)、以及手术部位感染、术后子宫内膜炎、产褥病率、血象变化、抗菌药的使用频度(DDDs)和费用、新生儿评分与感染进行比较.结果:2组产前基本情况、手术时间、术中出血差异无统计学意义(P＞0.05)；2组均未见手术部位感染,子宫内膜炎、产褥病率及血象升高等差异无统计学意义(P＞0 05)；短程与长程预防策略用于抗菌药的费用支出差异有统计学意义(P＜0.01),短程策略抗菌药物的DDDs仅约是长程策略的1/7(P＜0.01)；同时新生儿评分与感染等差异亦无统计学意义(P＞0.05).结论:头孢唑啉或联合甲硝唑短程策略(＜ 24 h)预防盆腔炎产妇手术部位感染效果与长程用药策略(＞48 h)相当,抗菌药物费用和用量明显下降.%Objective: To evaluate the effect of short-term prophylactic antibiotics (<24 h) on prevenlion maiernaleo-natal infectious morbidity of cesarean section in patients with pelvic inflammatory disease (PID). Methods: Two hundred and twenty-seven patients with PID were collected from patients with cesarean section. Patients were divided into 2 groups according to the short-term prophylaxis (<24 hours, n=lO9) or long-term prophylaxis (>48 hours, n=l 18). It was compared between the two groups including maternal trimester, body mass index, while blood cell count before surgery primipara, premature rupture of membranes,pregnancy-induced hypertension syndrome and surgical site infection(SSI),postoperative endometritis,puerperal morbidity, hemogram, frequency and cost of antibiotic defined daily dose (DDDs), neonatal score and infection. Results: There were no significant differences in the basic data, before operation, duration of surgery and blood loss during surgery between two groups (P >0.05). Also there were no significant differences in the incidence of SSI, endometritis, puerperal morbidity and hemogram between two groups (P > 0.05). It was found that the DDDs of short-term antibiotic prophylaxis strategy was 1/7 DDDs of long-term one (P < 0.0)), but no significant difference was found in the neonatal score and infection between two groups (P > 0.05). Conclusion: The effect of short-term (<24 houns) prophylaxis by cefazolin or combined with metrnntdazole was equivalent to the long-term strategies (> 48 h) in pelvic inflammatory diseases, with a decreased antibiotic usage and cost.