张彦 高杰 陶婧 缪丽燕

摘 要 目的：探討泌尿外科三、四级腹腔镜清洁手术患者术后预防使用抗菌药物的必要性。方法：选择2016年1月-2017年12月我院泌尿外科住院治疗的264例接受三、四级腹腔镜清洁手术患者。将所有患者分别以预防用药时间是否超过24 h分为≤24 h组（40例）和>24 h组（224例），以术后预防使用抗菌药物种类分为未预防组（36例）、一代头孢组（102例）、头霉素组（93例）和三代头孢组（33例）。观察所有患者的术后发热及术后切口感染发生情况，不同组别患者的术后发热情况、术后住院时间及人均抗菌药物总费用。 结果：264例患者中，术后发热≥38.0 ℃的有43例，其中有8例发热≥38.5 ℃；发热均发生在术后72 h内，其中术后24 h内发热的有34例，术后48 h内发热的有42例；持续发热2 d的有9例。另有1例患者发生术后切口感染。以预防用药时间是否超过24 h分的2组患者术后发热率、术后住院时间比较，差异均无统计学意义（P>0.05）；≤24 h组患者人均抗菌药物总费用显著低于>24 h组（P<0.05）。以术后预防使用抗菌药物种类分的4组患者术后发热率、术后住院时间比较，差异均无统计学意义（P>0.05）；一代头孢组、头霉素组、三代头孢组患者人均抗菌药物总费用均显著高于未预防组（P<0.05）。结论：我院泌尿外科三、四级腹腔镜清洁手术预防使用抗菌药物的问题较突出，主要表现为预防用药时间较长、术后换用较高级别抗菌药物不恰当，这不仅不会降低患者术后发热率、缩短术后住院时间，还会增加抗菌药物总费用。故建议对于泌尿外科三、四级腹腔镜清洁手术患者术后不需要预防使用抗菌药物。

关键词 预防使用；抗菌药物；泌尿外科；腹腔镜清洁手术；术后发热；住院时间；总费用

中图分类号 R969.3；R978.1 文献标志码 A 文章编号 1001-0408（2018）22-3138-04

DOI 10.6039/j.issn.1001-0408.2018.22.25

ABSTRACT OBJECTIVE： To investigate the necessity of postoperative prophylactic application of antibiotics in patients undergoing third and forth-level laparoscopic cleaning surgery in urinary surgery department. METHODS： Totally 264 patients undergoing third and forth-level laparoscopic cleaning surgery were selected from urinary surgery department of our hospital during Jan. 2016-Dec. 2017. All patients were divided into ≤24 h group （40 cases） and >24 h group （224 cases） according to whether the preventive medication time was more than 24 h. According to the types of antibiotics for postoperative use， those were divided into non-prevention group （36 cases）， first-generation cephalosporin group （102 cases）， cephalomycin group （93 cases） and third-generation cephalosporin group （33 cases）. The postoperative fever and postoperative incision infection of all patients， postoperative fever， postoperative hospitalization time and total antibiotics cost per capita of different groups were all observed. RESULTS： Among 264 patients， there were 43 cases of postoperative fever ≥38.0 ℃， among which there were 8 cases of postoperative fever ≥38.5 ℃. The postoperative fever occurred within 72 h， among which 34 fever cases occurred within 24 h and 42 cases within 48 h. There were 9 cases of 2 d persistent fever. One case suffered from incision infection after operation. There was no statistical significance in the incidence of postoperative fever or postoperative hospitalization time between 2 groups which were grouped according to the time of prophylactic drug use more than 24 h or not （P>0.05）. Total cost per capita of antibiotics in ≤24 h group was significantly lower than >24 h group （P<0.05）. There was no statistical significance in the incidence of postoperative fever or hospitalization time among 4 groups which were divided according to the type of antiboitics for prophylactic use （P>0.05）. Total cost per capita of antibiotics in first-generation cephalosporin group， cephalomycin group and third-generation cephalosporin group were significantly higher than non-prevention group （P<0.05）. CONCLUSIONS： There are obvious problems in prophylactic application of antibiotics in cleaning surgery of urinary surgery department in our hospital， mainly manifesting as longer duration of prevention and unsuitable use of higher level of antibiotics after surgerg； it will not only reduce the incidence of postoperative fever and postoperative hospitalization time， but also increase the total cost of antibiotics use. Therefore， prophylactic application of antibiotics is not necessary for patients with third and forth-level laparoscopic cleaning surgery in urinary surgery department.

KEYWORDS Prophylactic use； Antibiotics； Urinary surgery department； Laparoscopic cleaning surgery； Postoperative fever；Postoperative hospitalization time； Total cost

围术期预防使用抗菌药物可有效降低泌尿外科患者术后感染率[1-2]。随着腹腔镜技术在泌尿外科的迅速发展，其在减少患者术中及术后创伤、加快康复等方面发挥了越来越大的作用。国内外学者已尝试在腹腔镜清洁手术中不预防使用抗菌药物，结果发现这对降低预防使用抗菌药物强度具有积极的作用[3-4]。通过此方法我……