经导管肝动脉化疗栓塞术围手术期抗菌药物应用的前瞻性研究

Prospective Study of Antibiotic Usage During Perioperative Period for Transcatheter Hepatic Arterial Chemoembolization

关键词:  经导管动脉化疗栓塞术  围手术期  抗菌药物  合理用药

Key words:  transcatheter arterial chemoembolization(TACE)  perioperative period  antibiotics  rational administration

摘要:

目的 探讨单纯经导管肝动脉化疗栓塞术围手术期是否需要预防性应用抗菌药物。方法 根据围手术期抗菌药物使用情况采用纵断面分析研究方法并按照入选标准选取98例患者150例次经导管肝动脉化疗栓塞术，分为抗菌药物充分预防组、一般预防组、非预防组各50例次，预防组静脉滴注头孢美唑钠(1 g，bid)或头孢唑林(1 g，tid)，非预防组术围术期不用抗菌药物。比较3组术后栓塞综合征及感染的发生情况。结果 3组共123例患者出现发热，其中充分预防组42例，一般预防组41例，非预防组40例；125例患者出现中性粒细胞升高，其中充分预防组42例，一般预防组40例，非预防组43例；出现中性粒细胞+白细胞异常升高者共7例，其中充分预防组2例，一般预防组3例，非预防组2例，结合实验室检查及临床症状，无一例诊断为败血症，经术后抗感染治疗后血象恢复正常。3组术后栓塞综合症的发生情况没有统计学差异。结论 肝功能储备较好且术前无感染者行肝动脉化疗栓塞术围手术期没有必要预防性使用抗菌药物。

Abstract:

OBJECTIVE To investigate the necessity of prophylactic usage of antibiotics during perioperative period for transcatheter hepatic arterial chemoembolization(TACE). METHODS To use longitudinal analysis approach 98 patients’ 150 TACE was selected and divided into antibiotics sufficient prophylaxis group(50), general prophylaxis group(50) and non-prophylaxis group(50) according to their antibiotic medications during perioperative period. Cefmetazole sodium(1 g, bid) for sufficient prophylaxis group and cefazolin(1 g, tid) for general prophylaxis group were iv drip, any antibiotics was not used for non-prophylaxis group. Embolism syndrome and infection was compared with them. RESULTS All of 123 cases in 3 groups had a fever and in which 42 for sufficient antibiotics prophylaxis group, 41 for general prophylaxis group and 40 for non-prophylaxis group, respectively; 125 cases appeared elevated neutrophilic granulocytes in which 42 for sufficient antibiotics prophylaxis group, 40 for general prophylaxis group and 43 for non-prophylaxis group, respectively; 7 cases in 3 groups appeared elevated neutrophilic granulocytes accompanying abnormally elevated leukocytes in which 2 for sufficient antibiotics prophylaxis group, 3 for general prophylaxis group and 2 for non-prophylaxis group, respectively; incorporating laboratory examination and clinical symptoms no septicemia was diagnosed, their hem gram went back to normal after anti-infective therapy. There was no statistic differences in embolism syndrome among them. CONCLUSION There is no need to use antibiotics prophylacticly during perioperative period for TACE for patients with good hepatic reservoir and free from infection preoperatively.