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[手术中的抗生素预防]

[Antibiotic prophylaxis in surgery].

作者信息

Simo J, Matis P, Durdík S, Martinec A, Kubis J

机构信息

I. chirurgická klinika Fakultnej nemocnice, Mickiewiczova 13, 813 69 Bratislava 1.

出版信息

Bratisl Lek Listy. 1999 Dec;100(12):692-4.

Abstract

Infection remains a serious complication after surgical produces. The main risk factors for developing infection are: 1. endogenous-host related, 2. exogenous-produce related, 4. environmental-related ones. Systemic antibiotic prophylaxis significantly reduces the incidence of potentially serious infective complications. It is indicated in procedures with incidence of infective complications more as 5%, in clean contaminated wounds and also in produces, in which infection has fatal consequences (vascular surgery, heart surgery, traumatology). The decision to use antibiotic prophylaxis depends upon the operation to be performed, the findings at operations, the general health of the patient and pharmacological and antibacterial properties of the agent. Timing of the first dose (administration not more as 1 hour preoperatively) and duration not more as 24 hours are very important. We use the second generations of cephalosporins (cefuroxim and after antibiotic rotation cefamandol) in antibiotic prophylaxis obligatory in vascular surgery, pacemaker implantation, traumatology and in colorectal surgery (there in combination with metronidasol) with mean infection rate in clean surgical procedures from 0.5 to 1.5%. Complications after antibiotic prophylaxis are very rare. However antibiotic prophylaxis can not compensate the correction of medical problems preoperatively and the meticulous surgical technique.

摘要

感染仍然是手术后的一种严重并发症。发生感染的主要风险因素有:1. 与宿主内源性相关的;2. 与手术操作外源性相关的;4. 与环境相关的。全身性抗生素预防可显著降低潜在严重感染性并发症的发生率。在感染性并发症发生率超过5%的手术、清洁-污染伤口手术以及感染会导致致命后果的手术(血管手术、心脏手术、创伤外科)中都有应用指征。是否使用抗生素预防取决于即将进行的手术、手术中的发现、患者的总体健康状况以及所用药物的药理和抗菌特性。首剂给药时间(术前给药不超过1小时)和用药持续时间不超过24小时非常重要。在血管手术、起搏器植入、创伤外科以及结直肠手术(在此与甲硝唑联合使用)中,我们在抗生素预防中强制性使用第二代头孢菌素(头孢呋辛以及在抗生素轮换后使用头孢孟多),清洁手术的平均感染率为0.5%至1.5%。抗生素预防后的并发症非常罕见。然而,抗生素预防不能弥补术前医疗问题的纠正以及精细的手术技巧。

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