Galask R P
Department of Obstetrics and Gynecology, University of Iowa College of Medicine, Iowa City 52242.
J Reprod Med. 1990 Nov;35(11 Suppl):1078-81.
Physicians have evaluated the role of antibiotics in the prevention of perioperative infections since these drugs were discovered, but not until it was determined that antibiotics prevented staphylococcal wound infections in the animal model did surgeons consider their use for prophylaxis. In the 1970s, improved techniques in isolating and identifying anaerobic microorganisms and the unacceptably high incidence of infection-related complications convinced obstetricians to study, and ultimately accept, the use of perioperative antibiotic administration to prevent these infections. Recent progress has included refinement of the guidelines for patient selection and drug regimens. Although a single dose of an antibiotic given to the patient undergoing primary cesarean section has been demonstrated to be effective prophylaxis when administered after clamping the umbilical cord, this practice has not been widely accepted. With the discovery of cephamycins the role of these broad-spectrum antibiotics in obstetric and gynecologic surgery was investigated. One of the studies compared the efficacy of cefmetazole with that of cefotetan in preventing post-cesarean section infection. Eighteen patients in each group received a 2-g dose of one of the two drugs when the umbilical cord was clamped. Predetermined elevations in temperature were used to evaluate the presence of ensuing infections. Four subjects in each group developed some type of morbidity. Postoperative complications included wound infection, endometritis, bladder infection and cellulitis. Cefmetazole and cefotetan seemed equally effective in preventing post-cesarean section infections.
自抗生素被发现以来，医生们一直在评估其在预防围手术期感染中的作用，但直到确定抗生素能在动物模型中预防葡萄球菌伤口感染后，外科医生才开始考虑将其用于预防。在20世纪70年代，分离和鉴定厌氧微生物的技术得到改进，且与感染相关并发症的发生率高得令人难以接受，这促使产科医生研究并最终接受围手术期使用抗生素来预防这些感染。最近的进展包括完善了患者选择和药物治疗方案的指南。尽管已证明对接受初次剖宫产的患者在夹住脐带后给予单剂量抗生素是有效的预防措施，但这种做法尚未被广泛接受。随着头孢霉素的发现，人们对这些广谱抗生素在妇产科手术中的作用进行了研究。其中一项研究比较了头孢美唑和头孢替坦预防剖宫产术后感染的疗效。每组18名患者在夹住脐带时接受2克剂量的两种药物之一。以预先确定的体温升高来评估是否发生后续感染。每组有4名受试者出现了某种类型的发病情况。术后并发症包括伤口感染、子宫内膜炎、膀胱感染和蜂窝织炎。头孢美唑和头孢替坦在预防剖宫产术后感染方面似乎同样有效。
