van Dijk-van Dam M S, Moll F L, de Letter J A, Langemeijer J J, Kuks P F
Department of Vascular Surgery, St Antonius Hospital, Nieuwegein, The Netherlands.
Eur J Vasc Endovasc Surg. 1996 Nov;12(4):428-30. doi: 10.1016/s1078-5884(96)80008-6.
To determine whether a prophylactic second dose of antibiotics is justified when severe blood loss and/or prolonged operation time occurs during aortoiliac reconstructions.
We measured the cefuroxime concentration in venous blood serum and subcutaneous fat tissue of 30 patients who underwent elective aortoiliac reconstruction after a single intravenous dose of 1500 mg cefuroxime.
The mean blood loss was 1912 ml (range 200-7000). The mean operation time was 212 min (range 70-330). The cefuroxime concentration in blood serum 30 min after the gift varied from 53.7-561.6 mg/l and during closure of the abdominal incision from 13.2-90.0 mg/l. Taking the minimum inhibitory concentration for Staphylococcus species as 1.0 mg/l, we found an adequate prophylactic serum cefuroxime concentration in all patients. There was a statistically significant correlation between serum cefuroxime concentration and blood loss (p = 0.01) and operation time (p = 0.0001).
Although serum concentration of cefuroxime is greatly influenced by blood loss and operation time, a second dose of cefuroxime in aortoiliac reconstructions is not necessary if the operation is completed within 5.5 h and if perioperative blood loss does not exceed 7000 ml.
确定在主髂动脉重建术中出现严重失血和/或手术时间延长时，预防性使用第二剂抗生素是否合理。
我们测量了30例接受择期主髂动脉重建术患者在单次静脉注射1500毫克头孢呋辛后静脉血清和皮下脂肪组织中的头孢呋辛浓度。
平均失血量为1912毫升（范围200 - 7000毫升）。平均手术时间为212分钟（范围70 - 330分钟）。给药后30分钟血清中头孢呋辛浓度在53.7 - 561.6毫克/升之间，在关闭腹部切口时浓度在13.2 - 90.0毫克/升之间。以葡萄球菌属的最低抑菌浓度为1.0毫克/升，我们发现所有患者的血清头孢呋辛浓度均足以起到预防作用。血清头孢呋辛浓度与失血量（p = 0.01）和手术时间（p = 0.0001）之间存在统计学显著相关性。
虽然头孢呋辛的血清浓度受失血量和手术时间的影响很大，但如果手术在5.5小时内完成且围手术期失血量不超过7000毫升，则在主髂动脉重建术中无需使用第二剂头孢呋辛。
