Long S G, Smith A G, Perry B A, Leyland M J, Milligan D W
Birmingham Heartlands Hospital, England.
Qual Health Care. 1995 Sep;4(3):194-6. doi: 10.1136/qshc.4.3.194.
People who have had a splenectomy for any reason are 40 times more likely to have an overwhelming infection, especially pneumococcal infection, and 17 times more likely to suffer fatal sepsis. The incidence of such life threatening infections is reduced by prophylactic immunisation with polyvalent pneumococcal vaccine and long term antibiotic prophylaxis or instituting prompt antibiotic treatment in the event of fever. This haematology unit agreed a policy of immunisation and antibiotic prophylaxis in June 1988 for all patients undergoing elective splenectomy. The success of this policy was audited in July 1993 by a retrospective analysis of patients' case notes. Seventy four patients were identified as having had a splenectomy, 54 (73%) before June 1988, of whom only 13 (24%) had received both pneumococcal immunisation and antibiotic prophylaxis before implementation of the agreed policy. At the time of audit, 46/74 (62%) patients were recorded as having received immunisation and 64/74 (86%) as receiving antibiotic prophylaxis or a supply of antibiotics to take in the event of a fever. All but one of the 20 patients who had a splenectomy after June 1988, since implementation of the agreed policy, received immunisation and antibiotic prophylaxis. The authors conclude that establishment of a formal agreed policy for pneumococcal prophylaxis for patients undergoing splenectomy has improved the quality of care.
因任何原因行脾切除术的人发生暴发性感染的可能性要高40倍，尤其是肺炎球菌感染，发生致命性败血症的可能性要高17倍。通过使用多价肺炎球菌疫苗进行预防性免疫、长期抗生素预防或在发热时立即进行抗生素治疗，可降低此类危及生命感染的发生率。该血液科于1988年6月为所有接受择期脾切除术的患者制定了免疫和抗生素预防政策。1993年7月，通过对患者病历的回顾性分析对该政策的成效进行了审核。确定有74例患者接受了脾切除术，其中54例（73%）在1988年6月之前接受手术，在商定政策实施之前，这些患者中只有13例（24%）接受了肺炎球菌免疫和抗生素预防。在审核时，记录显示46/74（62%）的患者接受了免疫，64/74（86%）的患者接受了抗生素预防或备有发热时服用的抗生素。自商定政策实施以来，1988年6月之后接受脾切除术的20例患者中，除1例之外，其余均接受了免疫和抗生素预防。作者得出结论，为接受脾切除术的患者制定正式商定的肺炎球菌预防政策提高了护理质量。
