Lin Chen-Sung, Hsu Wen-Hu, Wu Yu-Chung, Huang Wen-Chieh, Wang Chien-Ying, Huang Min-Hsiung
Division of Thoracic Surgery, Department of Surgery, Taipei-Veterans General Hospital, Taipei, Taiwan, R.O.C.
J Chin Med Assoc. 2004 Jun;67(6):275-80.
Postoperative pneumonia is a major cause of mortality and morbidity after lung surgery. The effectiveness of prophylactic antibiotics for preventing postoperative pneumonia and the recovery course after pulmonary lobectomy is still not clarified yet. We conducted this study to evaluate the effectiveness of prophylactic antibiotics on the post-operative recovery course after pulmonary lobectomies.
Forty-five cases undergoing pulmonary lobectomies between June 2002 and January 2003 were enrolled in this prospective study. Each patient received prophylactic antibiotics of cefuroxime and sisomicin. Sputum culture upon admission and swab culture from the bronchus cut-end during operation were obtained. The clinical vital signs including heart rates, respiratory rates and core body temperature in the postoperative recovery courses were analyzed.
Four (8.9%) patients developed pneumonia after lobectomies, and pneumonia occurred only in patients who had positive culture results from bronchial cut-end. The organisms cultured from the sputum seemed to be controlled by prophylactic antibiotics. All the organisms cultured in the bronchus cut-end differed from those in the sputum; it denoted these pathogens were inoculated during anesthesia for surgical operation. The postoperative vital signs including tachycardia and fever improved gradually in the initial 3 days. Patients with pneumonia sustained significant higher fever than the non-pneumonic patients during postoperative course.
The short-term combination of cefuroxime and sisomicin offers sufficient effectiveness in prophylaxis of pneumonia after pulmonary surgery. Positive bronchial cut-end cultures were related to the post-lobectomy pneumonia significantly. Body temperature was the most useful presenting vital sign for early detection of the postoperative pneumonia.
术后肺炎是肺手术后死亡和发病的主要原因。预防性抗生素对预防术后肺炎的有效性以及肺叶切除术后的恢复过程仍未明确。我们开展这项研究以评估预防性抗生素对肺叶切除术后恢复过程的有效性。
本前瞻性研究纳入了2002年6月至2003年1月期间接受肺叶切除术的45例患者。每位患者接受头孢呋辛和西索米星预防性抗生素治疗。获取入院时的痰培养结果以及手术期间支气管切端的拭子培养结果。分析术后恢复过程中的临床生命体征，包括心率、呼吸频率和核心体温。
4例（8.9%）患者在肺叶切除术后发生肺炎，且肺炎仅发生在支气管切端培养结果为阳性的患者中。痰中培养出的微生物似乎被预防性抗生素所控制。支气管切端培养出的所有微生物均与痰中的不同；这表明这些病原体是在手术麻醉期间接种的。术后生命体征，包括心动过速和发热，在最初3天逐渐改善。肺炎患者在术后过程中的发热持续明显高于非肺炎患者。
头孢呋辛和西索米星的短期联合使用在预防肺手术后肺炎方面具有足够的有效性。支气管切端培养结果阳性与肺叶切除术后肺炎显著相关。体温是早期发现术后肺炎最有用的生命体征表现。
