McAllister T A, Fyfe A H, Young D G, Raine P A
Department of Microbiology, Royal Hospital for Sick Children, Glasgow.
Drugs. 1988;35 Suppl 2:127-32. doi: 10.2165/00003495-198800352-00027.
In an attempt to reduce postoperative sepsis, a series of randomised, double-blind studies was begun in 1982, using cefotaxime as backbone therapy. Up to 1985 (stages I and II), the best results were obtained using a combination of cefotaxime (75 mg/kg intravenously in 3 doses at 12-hourly intervals) plus metronidazole (10 mg/kg intravenously in 3 doses), both drugs administered 1 hour before surgery (preoperatively) or at anaesthetic induction (peroperatively). In 300 consecutive cases, the wound infection rates were 1% in uncomplicated acute appendicitis and 5% in perforated/gangrenous appendices. The present study (stage III) reports the findings in 401 consecutive patients: 215 treated with the above regimen, either pre- or perioperatively (group 1) and 186 who additionally had peritoneal lavage with cefotaxime 2 g/L during surgery (group 2). There were 16 wound infections overall, 2 among patients administered prophylaxis preoperatively and 14 in those administered prophylaxis perioperatively. All produced mixed cultures, with Escherichia coli, Streptococcus milleri and Bacteroides fragilis predominating. The overall figures for postoperative sepsis are 12/215 (5.6%) in the non-lavage group and 8/186 (4.3%) in the lavage group. Among patients with a perforated and/or gangrenous appendix, the wound infection rate was 8/72 (11.1%) in the non-lavage group (group 1) and 4/66 (6.1%) in the lavage group (group 2). Each group had 2 cases of pelvic abscess.
为降低术后败血症的发生率，1982年开始了一系列随机双盲研究，以头孢噻肟作为主要治疗药物。到1985年（第一阶段和第二阶段），采用头孢噻肟（75mg/kg静脉注射，分3剂，每12小时1次）加甲硝唑（10mg/kg静脉注射，分3剂）联合用药取得了最佳效果，两种药物均在手术前1小时（术前）或麻醉诱导时（术中）给药。在300例连续病例中，单纯性急性阑尾炎的伤口感染率为1%，穿孔性/坏疽性阑尾炎的伤口感染率为5%。本研究（第三阶段）报告了401例连续患者的研究结果：215例患者在术前或术中接受上述治疗方案（第1组），186例患者在手术期间另外接受了2g/L头孢噻肟的腹腔灌洗（第2组）。总共发生了16例伤口感染，术前接受预防用药的患者中有2例，术中接受预防用药的患者中有14例。所有感染均为混合培养，以大肠杆菌、米勒链球菌和脆弱拟杆菌为主。非灌洗组术后败血症的总体发生率为12/215（5.6%），灌洗组为8/186（4.3%）。在穿孔性和/或坏疽性阑尾炎患者中，非灌洗组（第1组）的伤口感染率为8/72（11.1%），灌洗组（第2组）为4/66（6.1%）。每组均有2例盆腔脓肿病例。
