脾切除术后预防措施的审计——我们是否遵循了指南？
An audit of post-splenectomy prophylaxis--are we following the guidelines?
作者信息
Ramachandra Jyothi, Bond Amanda, Ranaboldo Charles, Cullis Jonathan
机构信息
Department of General Medicine, Salisbury District Hospital, Salisbury, Wiltshire, UK.
出版信息
Ann R Coll Surg Engl. 2003 Jul;85(4):252-5. doi: 10.1308/003588403766274962.
INTRODUCTION
Asplenic individuals have major difficulties coping with specific infections (e.g. Streptococcus pneumoniae). This is an audit to look at a district general hospital's compliance with published guidelines for immunisations and antibiotic prophylaxis post-splenectomy.
PATIENTS AND METHODS
A retrospective review of hospital records of consecutive splenectomy patients from January 1996 to March 2001.
RESULTS
Of 76 patients, 72% were vaccinated (30/76 with pneumococcal, HIB and meningococcal vaccines, 15/76 with Pneumovax and HIB, 10/76 with Pneumovax only), 63% were discharged on prophylactic antibiotics, and 81% of surviving patients had adequate communication with the GP regarding splenectomy. Patients undergoing non-elective splenectomy were less likely to be vaccinated or receive prophylactic antibiotics when compared with elective splenectomy patients.
CONCLUSIONS
Results are comparable with other published studies, but are still unsatisfactory for many splenectomy patients. Vaccination rates must be improved and more information given to patients and GPs to allow for appropriate follow-up care.
引言
无脾个体在应对特定感染（如肺炎链球菌）时存在重大困难。本次审计旨在考察一家地区综合医院对脾切除术后免疫接种和抗生素预防的已发布指南的遵循情况。
患者与方法
对1996年1月至2001年3月连续脾切除患者的医院记录进行回顾性分析。
结果
76例患者中，72%接受了疫苗接种（76例中有30例接种了肺炎球菌、b型流感嗜血杆菌和脑膜炎球菌疫苗，15例接种了肺炎球菌多糖疫苗和b型流感嗜血杆菌疫苗，10例仅接种了肺炎球菌多糖疫苗），63%出院时接受了预防性抗生素治疗，81%的存活患者与全科医生就脾切除术进行了充分沟通。与择期脾切除患者相比，非择期脾切除患者接种疫苗或接受预防性抗生素治疗的可能性较小。
结论
结果与其他已发表的研究相当，但对许多脾切除患者来说仍不令人满意。必须提高疫苗接种率，并向患者和全科医生提供更多信息，以便进行适当的后续护理。
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