中国胸心血管外科临床杂志

中国胸心血管外科临床杂志

围手术期规范使用抗生素对胸外科手术临床指标影响的病例对照研究

查看全文

目的 探讨规范使用抗生素对胸外科术后肺部感染率、切口感染率、术后平均住院时间及总住院费用等临床指标的影响。 方法 纳入四川大学华西医院胸外科手术预防用药规范执行后 3 个月(2011 年 8~10 月)住院并接受手术治疗的 468 例患者(观察组)和规范执行前一年同期(2010 年 8~10 月)的 343 例患者(对照组)。其中观察组男 326 例、女 142 例,年龄(52.0±15.5)岁;对照组男 251 例、女 92 例,年龄(51.4±15.9)岁。比较两组患者预防使用抗生素的级别、用药时间、抗生素费用、术后切口感染及肺部感染发生率、术后住院时间及总住院费用等。 结果 观察组与对照组相比,预防使用抗生素的时间明显缩短[(3.6±2.4)d vs.(6.1±3.1)d,P=0.020],抗生素使用总费用显著降低[(1 230.0±2 151.0)元 vs.(2 252.0±1 764.0)元,P<0.001]。两组患者的住院费用差异无统计学意义[(36 345.0±13 320.0)元vs.(35 821.0±11 991.0)元,P=0.566];术后住院时间无明显变化[(10.6±8.4)d vs.(10.7±5.3)d,P=0.390];术后切口感染发生率和术后肺部感染发生率差异无统计学意义(1.5% vs. 2.3%,P=0.430;19.2% vs. 22.2%,P=0.330)。 结论 规范胸外科手术预防使用抗生素不会引起术后肺部感染和切口感染率升高,对临床指标无负面影响。显著降低使用抗生素的级别对缩短用药时间、减少院内感染、降低耐药菌株的发生率可能有积极作用。

Objective To explore the effect of standardized use of antibiotics on clinical indicators after thoracic surgery, such as pulmonary infection rate, incision infection rate, average length of hospital stay and total hospitalization cost. Methods We selected 468 patients (an observation group) who were hospitalized and received thoracic surgery from August to October 2011, 3 months after the implementation of the preventive antibiotics use protocol for thoracic surgery in West China Hospital, Sichuan University, and selected 343 patients (a control group) in the same period of the previous year (from August to October 2010). There were 326 males and 142 females with a mean age of 52.0±15.5 years in the observation group, and 251 males and 92 females with a mean age of 51.4±15.9 years in the control group. The level of antibiotic use, medication time, antibiotics cost, postoperative incision infection, incidence of pulmonary infection, postoperative hospital stay and total hospitalization cost were compared between the two groups. Results Compared with the control group, the time for preventive use of antibiotics was significantly shorter in the observation group (3.6±2.4 d vs. 6.1±3.1 d, P=0.020) and the total cost of antibiotic use significantly reduced (1 230.0±2 151.0 yuan vs.2 252.0±1 764.0 yuan, P<0.001). There was no significant difference between the two groups in hospitalization cost(36 345.0±13 320.0 yuanvs. 35 821.0±11 991.0 yuan, P=0.566), postoperative hospital stay (10.6±8.4 d vs. 10.7±5.3 d, P=0.390), the incidence of postoperative wound infection or postoperative pulmonary infection (1.5% vs. 2.3%, P=0.430; 19.2% vs. 22.2%, P=0.330). Conclusion The standardized use of antibiotics in thoracic surgery does not cause postoperative pulmonary infection and incision infection, and has no negative impact on clinical indicators. Significantly reducing the level of antibiotics use may have a positive effect on reducing medication time, in-hospital infection and the incidence of drug-resistant strains.

关键词: 预防; 手术; 抗生素; 胸外科

Key words: Prevention; surgery; antibiotics; thoracic surgery

引用本文: 廖虎, 宋尚歧, 蒲强, 梅建东, 肖志兰, 夏梁, 刘伦旭. 围手术期规范使用抗生素对胸外科手术临床指标影响的病例对照研究. 中国胸心血管外科临床杂志, 2018, 25(5): 393-396. doi: 10.7507/1007-4848.201711065 复制

登录后 ,请手动点击刷新查看全文内容。 没有账号,
登录后 ,请手动点击刷新查看图表内容。 没有账号,
1. Zhang R, Eggleston K, Rotimi V, et al. Antibiotic resistance as a global threat: evidence from China, Kuwait and the United States. Global Health, 2006, 2: 6.
2. Taubes G. The bacteria fight back. Science, 2008, 321(5887): 356-361.
3. Kunin CM, Johansen KS, Worning AM, et al. Report of a symposium on use and abuse of antibiotics worldwide. Rev Infect Dis, 1990, 12(1): 12-19.
4. Hvistendahl M. Public health. China takes aim at rampant antibiotic resistance. Science, 2012, 336(6083): 795.
5. Bratzler DW, Houck PM, Surgical Infection Prevention Guideline Writers Workgroup. Antimicrobial prophylaxis for surgery: an advisory statement from the National Surgical Infection Prevention Project. Am J Surg, 2005, 189(4): 395-404.
6. 中华医学会外科学分会, 中华外科杂志编辑委员会. 围手术期预防使用抗菌药物指南. 中华外科杂志, 2006, 44(23): 1594-1596.
7. 何绥平, 黎沾良, 颜青. 围手术期预防应用抗菌药物调查分析. 中华外科杂志, 2008, 46(1): 12-14.
8. 陈刚, 肖朴, 花柱明, 等. 胸外科手术预防性应用抗生素的临床研究. 中华医院感染学杂志, 2003, 13(3): 266-268.
9. 姜丽岩, 何礼贤, 李善群, 等. 手术相关肺炎的高危因素. 上海医科大学学报, 2000, 27(5): 390-392.
10. Swoboda SM, Merz C, Kostuik J, et al. Does intraoperative blood loss affect antibiotic serum and tissue concentrations? Arch Surg, 1996, 131(11): 1165-1171.
11. 崔少罡, 白玲, 常诚, 等. 剖胸术后切口感染经济损失病例对照分析. 中华医院感染学杂志, 2002, 12(2): 87-88.