Kendrick James E, Numnum T Michael, Estes Jacob M, Kimball Kristopher J, Leath Charles A, Straughn J Michael
Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Alabama at Birmingham, AL 35249-7333, USA.
J Am Coll Surg. 2008 Sep;207(3):393-7. doi: 10.1016/j.jamcollsurg.2008.04.001. Epub 2008 Jun 2.
To develop a standardized protocol for management of postoperative fever in gynecology patients to decrease unnecessary diagnostic workups and empiric use of antibiotics.
A prospective analysis of postoperative gynecology patients identified those who experienced fever (maximum temperature [T(max)] > 100.4 degrees F). Patients were triaged into low- and high-risk groups. High-risk patients were managed independent of the protocol. High-risk criteria included bowel operation, preoperative infection, immunodeficiency, indwelling vascular access, mechanical heart valves, and intensive care unit admissions. Low-risk patients were treated with observation and antipyretics. Patients with persistent or high fever, defined as T(max) > 101 degrees F for > 48 hours, were evaluated and treated based on physical examination findings.
We evaluated 292 postoperative patients. Forty-seven percent of patients had a final diagnosis of malignancy. Sixty-four patients were high-risk and 33% of these patients experienced fever. Using the standardized protocol, 228 low-risk patients were managed. Thirty-seven of the 228 patients (16%) had fever postoperatively. Nineteen patients had low-grade fever (100.4 to 101 degrees F); none of these patients required antibiotics. Seventeen patients had fever (101.1 to 102 degrees F) and one patient had fever > 102 degrees F. Using the protocol, 6 of 37 patients (16%) were treated with antibiotics for an infectious diagnosis.
Although postoperative fever is common in gynecologic patients, the incidence of infection is low (3%). A standardized postoperative fever protocol in low-risk gynecology patients decreases use of empiric antibiotics without compromising morbidity.
制定一项针对妇科患者术后发热管理的标准化方案，以减少不必要的诊断检查和经验性使用抗生素的情况。
对术后妇科患者进行前瞻性分析，确定那些出现发热（最高体温[T(max)]>100.4华氏度）的患者。将患者分为低风险和高风险组。高风险患者不按照该方案进行管理。高风险标准包括肠道手术、术前感染、免疫缺陷、留置血管通路、机械心脏瓣膜以及入住重症监护病房。低风险患者采用观察和使用退烧药进行治疗。对于持续发热或高热（定义为T(max)>101华氏度超过48小时）的患者，根据体格检查结果进行评估和治疗。
我们评估了292例术后患者。47%的患者最终诊断为恶性肿瘤。64例患者为高风险，其中33%的患者出现发热。使用标准化方案管理了228例低风险患者。228例患者中有37例（16%）术后发热。19例患者为低热（100.4至101华氏度）；这些患者均未使用抗生素。17例患者发热（101.1至102华氏度），1例患者发热>102华氏度。按照该方案，37例患者中有6例（16%）因感染诊断接受了抗生素治疗。
虽然术后发热在妇科患者中很常见，但感染发生率较低（3%）。低风险妇科患者的标准化术后发热方案可减少经验性抗生素的使用，且不影响发病率。
