创伤性血气胸行胸腔闭式引流术后使用经验性抗生素预防脓胸和肺炎——一项多中心试验
Use of presumptive antibiotics following tube thoracostomy for traumatic hemopneumothorax in the prevention of empyema and pneumonia--a multi-center trial.
作者信息
Maxwell Robert A, Campbell Donald J, Fabian Timothy C, Croce Martin A, Luchette Fred A, Kerwin Andrew J, Davis Kimberly A, Nagy Kimberly, Tisherman Samuel
机构信息
Department of Surgery, University Of Tennessee-Chattanooga Unit, Chattanooga, Tennessee, 37403, USA.
出版信息
J Trauma. 2004 Oct;57(4):742-8; discussion 748-9. doi: 10.1097/01.ta.0000147481.42186.42.
OBJECTIVE
To determine whether presumptive antibiotics reduce the risk of empyema or pneumonia following tube thoracostomy for traumatic hemopneumothorax.
METHODS
A prospective, randomized, double-blind trial was performed comparing the use of cefazolin for duration of tube thoracostomy placement (Group A) versus 24 hours (Group B) versus placebo (Group C).
RESULTS
A total of 224 patients received 229 tube thoracostomies. Logistic regression analysis revealed that duration of tube placement and thoracic acute injury score were predictive of empyema (p <0.05). Empyema tended to occur more frequently in patients with penetrating injuries (p=0.09). chi analysis showed pneumonia occurred significantly more frequently in blunt than penetrating injuries (p <0.05). Presumptive antibiotic use did not significantly effect the incidence of empyema or pneumonia, although no empyemas occurred in Group A.
CONCLUSIONS
The incidence of empyema was low and the use of presumptive antibiotics did not appear to reduce the risk of empyema or pneumonia.
目的
确定预防性使用抗生素是否能降低创伤性血气胸行胸腔闭式引流术后发生脓胸或肺炎的风险。
方法
进行一项前瞻性、随机、双盲试验，比较胸腔闭式引流管留置期间使用头孢唑林（A组）、使用24小时（B组）与使用安慰剂（C组）的效果。
结果
共有224例患者接受了229次胸腔闭式引流术。逻辑回归分析显示，引流管留置时间和胸部急性损伤评分可预测脓胸的发生（p<0.05）。穿透伤患者脓胸发生率往往更高（p=0.09）。卡方分析显示，钝性伤患者肺炎发生率显著高于穿透伤患者（p<0.05）。尽管A组未发生脓胸，但预防性使用抗生素对脓胸或肺炎的发生率并无显著影响。
结论
脓胸发生率较低，预防性使用抗生素似乎并未降低脓胸或肺炎的风险。
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