Zivný J, Mára M, Jedlicková A, Fucíková Z, Krejcí V, Dohnalová J
II. gynek.-porod. klinika 1. LF UK a VFN, Praha.
Ceska Gynekol. 1997 Aug;62(4):204-12.
Infections are still the most frequent postoperative complications and one of the limiting factors of successful gynaecological surgery. In recent years information on successful anti-microbial chemoprophylaxis is increasing and is associated with reduced postoperative inflammations, febrile morbidity and early complications. Views differ above all as regards indications for the use of antibiotic prophylaxis and the selection of a suitable antibiotic. Data in the literature differ also as regards achieved results. The submitted work had the objective to test on a representative group the success and rationality of medicamentous prophylaxis in gynaecological surgery and to contribute to a clearer view on controversial points. 203 women admitted to the Second Gynaecological and Obstetric Department of the First Medical Faculty Charles University and General Faculty Hospital Prague for elective abdominal or vaginal hysterectomy on account of a benign indication were divided into three groups which did not differ from the demographic or medical aspect. In group A (53 women) for prophylaxis two doses of Augmentin were used (combination of amoxycillin with clavulanic acid) i.v., patients in group M (50 women) had three doses of Mandol (Cefamandol) i.m., and in control group K (100 patients) no antibiotics were administered prophylactically. The authors investigated the postoperative course and evaluated some parameters in relation to possible postoperative infectious complications. The results proved unequivocally that prophylaxis with Augmentin reduces significantly the postoperative infectious morbidity (11.5%), febrile morbidity (5.6%) and the incidence of early infectious complications (3.8%) after abdominal or vaginal hysterectomy, as compared with the control group (35%, 31% and 11% resp.). Prophylaxis with Cefamandol reduced only in few parameters postoperative complications, but in general did not lead to a significant improvement of the postoperative course nor to a reduction of postoperative inflammatory complications. Similar results were obtained when only complications after abdominal hysterectomy were evaluated. The results of bacteriological examination confirmed the expected differences in the spectrum of efficacy of the two antibiotics on the most common microbial flora in the given area, i.e. a high sensitivity of Augmention to enterococci and bacterioids and resistance of these bacteria to Mandol. These results can be considered one of the reasons of different results of the two antibiotics. Prophylaxis with amoxycillin/clavulanic acid was found to be safe, very effective and financially feasible prevention of postoperative infectious complications after abdominal and vaginal hysterectomy. It led to a significant increase in the number of cases without any complications, when compared with the control group.
感染仍是最常见的术后并发症，也是妇科手术成功的限制因素之一。近年来，关于成功的抗菌化学预防的信息不断增加，且与术后炎症、发热发病率及早期并发症的减少相关。尤其在抗生素预防的使用指征和合适抗生素的选择方面，观点存在差异。文献中的数据在取得的结果方面也有所不同。本研究旨在对一组具有代表性的人群测试妇科手术中药物预防的成功率和合理性，并有助于更清晰地看待有争议的问题。因良性指征入住布拉格查理大学第一医学院和综合医院第二妇产科接受择期腹部或阴道子宫切除术的203名女性被分为三组，这三组在人口统计学或医学方面无差异。A组（53名女性）预防性静脉注射两剂奥格门汀（阿莫西林与克拉维酸的组合），M组（50名女性）肌肉注射三剂 Mandol（头孢孟多），K对照组（100名患者）未进行预防性抗生素给药。作者调查了术后病程，并评估了一些与可能的术后感染并发症相关的参数。结果明确证明，与对照组（分别为35%、31%和11%）相比，奥格门汀预防可显著降低腹部或阴道子宫切除术后的感染发病率（11.5%）、发热发病率（5.6%）和早期感染并发症的发生率（3.8%）。头孢孟多预防仅在少数参数上降低了术后并发症，但总体上并未导致术后病程的显著改善，也未降低术后炎症并发症。仅评估腹部子宫切除术后的并发症时，也获得了类似结果。细菌学检查结果证实了两种抗生素对给定区域最常见微生物菌群的疗效谱存在预期差异，即奥格门汀对肠球菌和拟杆菌具有高敏感性，而这些细菌对 Mandol 耐药。这些结果可被视为两种抗生素结果不同的原因之一。发现阿莫西林/克拉维酸预防对于腹部和阴道子宫切除术后的术后感染并发症是安全、非常有效且经济可行的预防措施。与对照组相比，它导致无任何并发症的病例数量显著增加。
