摘要目的 探讨择期结直肠手术预防性应用抗生素的合理方案.方法 将165例接受结直肠手术的患者随机分成3组:治疗1组(55例)在术前晚服用硫酸镁行肠道准备,麻醉诱导期静脉给予抗生素(头孢拉定2.0 g),术后追加应用2次抗生素(头孢拉定2.0 g、0.5%甲硝唑100 ml静脉滴注,24 h内相隔12 h应用);治疗2组(50例)在治疗1组基础上,术后持续使用抗生素3～5 d;对照组(60例)在治疗2组基础上,术前口服抗生素2～3 d(甲硝唑0.4 g,每日3次,卡那霉素0.2 g,每日3次).观察比较三组患者术后并发症(手术部位感染、吻合口漏、肠道菌群失调等)、术后白细胞变化、体温、住院时间和费用等指标.结果 三组在术后手术部位感染、吻合口漏、术后白细胞计数及其下降幅度、术后体温、住院时间等方面差异均无统计学意义(P＞0.05);治疗1组菌群失调发生率显著低于对照组(P＜0.05);治疗1组平均抗生素使用费用显著低于另外两组(P＜0.05).结论 麻醉诱导期静脉给予抗生素,术后24 h后停用抗生素是择期结直肠手术预防性应用抗生素的合理方案,可有效预防术后手术部位感染,抗生素相关不良反应少,并具有良好的经济效益.

abstractsObjection To investigate the reasonable proposal of prophylactic antibiotics use in selective colorectal operation.Methods One hundred and sixty-five patients underwent colorectal surgery were randomized to Treatment1(55 cases),Treatment2(50 cases)and Control(60 cases)group.The Treatment1 group was given oral MgSO4 solution at the night before operation,and Cefradine 2.0 g(I.V.)during the induction of anesthesia.continued with tow times of intravenous Cefradine 2.0 g and 0.5%Metronidazole 100 ml at an interval of 12 hours in 24 hours after the operation.The Treatment2 group was given the same treatment as Treatment1,but the antibiotics would not be withdrawn until 3-5 d after operation.On the basis of the treatment of Treatment2 group,the Control group was given oral antibiotics 2-3 days before operation.Postoperative complications including surgical site infection,stoma leakage,dysbacteriosis,and WBC,body temperature,days of hospitalization and antibiotic expenses in the three groups were observed and compared.Results There was no significant differences in surgical site infection,stoma leakage,WBC counting and its change,body temperature and hospital stay among the three groups (P＞0.05).The incidence rate of dysbacteriosis in Control group was significantly higher than that in Treatmentl group(P＜0.05).The antibiotic expenses in the Treatmentl group was significantly lower than those of the other two groups(P＜0.05).Conclusions Prophyrlactic antibiotic use during the induction of anesthesia and 24 hours after operation was reasonable in selective coloreetal operation,it can prevent the surgical site infection effectively with good social-economic effects and fewer side effects.