CAJ | 학술논문

目的探讨抗生素在耳后扩张器植入术围手术期感染预防中的合理应用. 方法研究对象为2013年2月4日至7月10日在北京协和医院行耳后扩张器植入术的连续病例63例.2月4日至6月9日住院的手术患者术前30 min至术后第2天连续3d应用头孢美唑钠1～2 g、2次/d静脉滴注(用药3d组);6月13日至7月10日住院的手术患者仅术前30 min一次性静脉滴注头孢呋辛0.75～1.50 g,30 min内滴完(单次用药组).用药3d组32例,男性26例,女性6例,年龄6～38岁,平均(11.5±6.5)岁,其中＜14岁26例,14～17岁3例,≥18岁3例.单次用药组31例,男性26例,女性5例,年龄6 ～32岁,平均(12.3±6.3)岁,其中＜14岁22例,14～17岁5例,≥18岁4例.2组患者年龄差异无统计学意义(P=0.73).所有患者均植入50 ml肾形扩张器.术后均放置负压引流管,至引流液变为淡黄色血清样液体且＜5 ml/d后拔除.观察2组患者围手术期切口感染和不良反应发生情况. 结果用药3d组患者术后4～5d拔除引流管,平均4.4d;单次用药组患者术后3.5～4.5 d拔除引流管,平均4.2d,2组拔管时间差异无统计学意义(P=0.07).2组患者切口均一期愈合,无一例出现感染、血肿等并发症.用药3d组和单次用药组各有1例患儿拆除包扎敷料后耳后皮肤出现湿疹或疱疹样改变,单次用药组1例患儿术后出现颈胸部皮疹,经对症治疗后均痊愈.结论耳后扩张器植入术前30 min一次性应用杀菌性抗生素足以预防术后感染,是值得临床推广应用的抗生素合理用药方案.
목적 탐토항생소재이후확장기식입술위수술기감염예방중적합리응용. 방법 연구대상위2013년2월4일지7월10일재북경협화의원행이후확장기식입술적련속병례63례.2월4일지6월9일주원적수술환자술전30 min지술후제2천련속3d응용두포미서납1～2 g、2차/d정맥적주(용약3d조);6월13일지7월10일주원적수술환자부술전30 min일차성정맥적주두포부신0.75～1.50 g,30 min내적완(단차용약조).용약3d조32례,남성26례,녀성6례,년령6～38세,평균(11.5±6.5)세,기중＜14세26례,14～17세3례,≥18세3례.단차용약조31례,남성26례,녀성5례,년령6 ～32세,평균(12.3±6.3)세,기중＜14세22례,14～17세5례,≥18세4례.2조환자년령차이무통계학의의(P=0.73).소유환자균식입50 ml신형확장기.술후균방치부압인류관,지인류액변위담황색혈청양액체차＜5 ml/d후발제.관찰2조환자위수술기절구감염화불량반응발생정황. 결과 용약3d조환자술후4～5d발제인류관,평균4.4d;단차용약조환자술후3.5～4.5 d발제인류관,평균4.2d,2조발관시간차이무통계학의의(P=0.07).2조환자절구균일기유합,무일례출현감염、혈종등병발증.용약3d조화단차용약조각유1례환인탁제포찰부료후이후피부출현습진혹포진양개변,단차용약조1례환인술후출현경흉부피진,경대증치료후균전유.결론 이후확장기식입술전30 min일차성응용살균성항생소족이예방술후감염,시치득림상추엄응용적항생소합리용약방안.
Objective To investigate the rational use of antibiotics for infection prophylaxis in retroauricular expander implantation during perioperative period.Methods The subjects were 63consecutive patients,who received retroauricular expander implantations in Peking Union Medical College Hospital from February 4th,2013 to July 10th,2013.The surgical patients hospitalized from February 4th to June 9th received Ⅳ infusion of sodium cefmetazole 1-2 g twice daily from 30 min before the operation to 2days after the operation in 3 consecutive days (the 3-day medication group); the surgical patients hospitalized from June 13th to July 10th received only one time of Ⅳ infusion of cefuroxime 0.75-1.50 g 30min before the operation and the infusion must be finished within 30 min (the one-time medication group).There were 32 patients in the 3-day medication group.Of them,26 patients were men and 6 were women with ages from 6 to 38 years and an average age of (11.5 ± 6.5) years ; 26 patients were ＜ 14 years,3 were 14-17 years,and 3 were ≥18 years.There were 31 patients in the one-time medication group.Of them,26 patients were men and 5 were women with ages from 6 to 32 years and an average age of (12.3 ± 6.3)years; 22 patients were ＜ 14 years,5 were 14-17 years,and 4 were ≥18 years.There was no significant difference in ages between the 2 groups (P =0.73).All patients were implanted with 50 ml reniform expander.Negative pressure drainage tubes were placed in all surgical patients and could not be pulled out until the liquid became serum-like fluid with light-yellow color and less than 5 ml.The situation of surgical site infections and adverse reactions during perioperative period were observed.Results The drainage time was 4-5 days with an average of 4.4 days in the 3-day medication group and 3.5-4.5 days with an average of 4.2 days in the one-time medication group.There was no significant difference in the drainage time between the 2 groups (P =0.07).The incisions in all patients healed well and no infections or hematoma occurred.Eczema or herpetiform changes on skin behind ear appeared in one patient in the threeday medication group and in one patient in the one-time medication group,respectively.One patient developed rashes on the neck and chest in the one-time medication group.The rashes disappeared after symptomatic treatments.Conclusions Preoperative one-time treatment with bactericidal antibiotics is enough for postoperative infection prophylaxis in retroauricular expander implantation.It's a rational regimen of antibiotic use and worthy of clinical popularization.