Elledge E S, Whiddon R G, Fraker J T, Stambaugh K I
Department of Surgery, Brooke Army Medical Center, Fort Sam Houston, TX 78234-6200.
Otolaryngol Head Neck Surg. 1991 Dec;105(6):836-9. doi: 10.1177/019459989110500611.
The use of systemic antibiotics for major head and neck surgical procedures involving the upper aerodigestive tract is now accepted as an important part of perioperative patient care. Despite knowledge of the high counts of bacteria present in saliva, no preoperative regimen for preparing the mouth has been standardized. Surgical wounds come in contact with saliva during the course of many head and neck procedures. While wound infection rates have been decreased with the use of prophylactic systemic antibiotics, serious morbidity still exists from postoperative wound infections. Reducing the bacterial counts in saliva preoperatively may further decrease wound infection rates. A prospective randomized pilot study of twenty healthy human subjects compared the effects of an oral rinse with clindamycin vs. a placebo rinse of normal saline. There was a statistically significant reduction in both aerobic and anaerobic colony counts in the clindamycin group at 4 hours after treatment. For the group that rinsed with placebo, there was an actual increase in counts 4 hours after treatment. It is concluded that oral rinses with clindamycin can reduce the bacterial content of saliva for a sufficient length of time to be effective as a preoperative prophylactic measure for head and neck surgery involving the upper aerodigestive tract. Future studies are planned to evaluate other potentially effective agents. A logical continuation is a clinical study of preoperative and postoperative rinses.
对于涉及上呼吸道消化道的头颈部大手术，全身性抗生素的使用现已被视为围手术期患者护理的重要组成部分。尽管已知唾液中存在大量细菌，但尚未制定出标准化的术前口腔准备方案。在许多头颈部手术过程中，手术伤口会与唾液接触。虽然预防性使用全身性抗生素已降低了伤口感染率，但术后伤口感染仍会导致严重的发病率。术前降低唾液中的细菌数量可能会进一步降低伤口感染率。一项针对20名健康受试者的前瞻性随机试验性研究比较了克林霉素口腔含漱液与生理盐水安慰剂含漱液的效果。治疗后4小时，克林霉素组的需氧菌和厌氧菌菌落计数均有统计学意义的显著降低。对于用安慰剂含漱的组，治疗后4小时菌落计数实际上有所增加。得出的结论是，克林霉素口腔含漱液可在足够长的时间内降低唾液中的细菌含量，作为涉及上呼吸道消化道的头颈部手术的术前预防措施有效。计划开展进一步研究以评估其他潜在有效的药物。合理的后续研究是进行术前和术后含漱的临床研究。
