Ishida T, Nakano K, Nakatani H, Gomi A, Sato T, Saegusa N, Itoh A, Okada J, Tazawa Y
Department of Cardiovascular Surgery, Kanto Medical Center NTT EC, Tokyo, Japan.
Kyobu Geka. 2001 Mar;54(3):207-10.
In this prospective study, we evaluated contamination of surgical fields in open heart operations by salvaged blood culture used in autologous transfusions device (Cell Saver 5, Heamonetics Corp., Braintree, MA, USA). And also, we prospectively investigated an efficacy of pre- and intra-operative prophylactic antibiotics administrations (cefazolin). Thirty patients undergone open heart surgeries with median sternotomy enrolled in this study. The patients were divided into two groups, group A (n = 15); without prophylactic antibiotics administration, group B (n = 15); with pre- and intra-operative prophylactic antibiotics administrations. Blood samples were drawn through the right atrium after the discontinuation of CPB and from salvaged blood bags. Bacterial growth was detected in 80.0% of salvaged blood samples in group A, 86.7% in group B (p = 0.62). Whereas no bacterial growth detection in blood samples though the right atrium. Quantitative estimates of contaminations showed 1.06 +/- 1.41, 0.90 +/- 1.24 cfu/ml, respectively (p = 0.22). Although bacterial growth rate were not statistically significant difference between groups, detective rate of Staphylococci was remarkably decreased (p = 0.005) in group B. Pre- and intra-operative prophylactic antibiotics administrations were effective for Staphylococci, but not whole microorganisms. In conclusion, salvaged blood used in autologous transfusions was highly contaminated and it suggests that surgical fields were not clear. Prophylactic antibiotics administrations were effective especially for Staphylococci.
在这项前瞻性研究中，我们评估了用于自体输血装置（美国马萨诸塞州布伦特里市海莫奈蒂克斯公司的Cell Saver 5）的回收血培养物对心脏直视手术手术野的污染情况。此外，我们还前瞻性地研究了术前和术中预防性使用抗生素（头孢唑林）的效果。本研究纳入了30例行正中胸骨切开术的心脏直视手术患者。患者分为两组，A组（n = 15）：未预防性使用抗生素；B组（n = 15）：术前和术中预防性使用抗生素。在体外循环停止后，通过右心房采集血样，并从回收血袋中采集血样。A组80.0%的回收血样检测到细菌生长，B组为86.7%（p = 0.62）。而通过右心房采集的血样未检测到细菌生长。污染的定量估计分别为1.06±1.41、0.90±1.24 cfu/ml（p = 0.22）。尽管两组之间细菌生长率无统计学显著差异，但B组葡萄球菌的检出率显著降低（p = 0.005）。术前和术中预防性使用抗生素对葡萄球菌有效，但对所有微生物无效。总之，自体输血中使用的回收血污染严重，这表明手术野不清洁。预防性使用抗生素尤其对葡萄球菌有效。
