摘要目的 探讨低感染风险剖宫产产妇围手术期预防性应用抗生素的必要性及最佳用药方案.方法 前瞻性随机对照研究低感染风险子宫下段剖宫产产妇围手术期抗生素应用与否以及不同用药方案与术后病率和术后感染的关系.抗生素选择头孢唑肟钠或克林霉素,均为静脉给药.共纳入2007年11月至2008年10月在南京大学医学院附属鼓楼医院妇产科分娩的产妇720例,随机分成4组:A组176例,围手术期不使用抗生素,B组190例,术前30 min一次给药,术后不再使用;C组180例,术前30 min开始给药,术后继续使用2 d;D组174例,手术结束后开始给药,共5d.比较4组产妇术后体温恢复正常的时间、术后病率、术后感染及术后住院天数.统计学分析采用方差分析、卡方检验及Fisher精确概率法. 结果 720例产妇术后感染率、术后病率分别为0.83%(6/720)和4.58%(33/720),4组产妇剖宫产术后感染发生率差异无统计学意义(P>0.05),B组和C组产妇术后体温恢复正常时间、术后病率及术后平均住院天数均分别显著低于A组和D组[B组:(41.9±31.6)h、1.05 oA(2/190)、(4.8±1.1)d;C组:(41.1±36.5)h、1.11%(2/180)、(4.7±0.9)d;A组:(67.0±40.6)h,7.39%(13/176)、(5.7±1.0)d,D组:(70.1±39.9)h、9.20%(16/174)、(5.9±1.1 d),P均<0.01].但B、C组之间和A,D组之间各项指标比较差异无统计学意义(P>0.05). 结论 低感染风险产妇剖宫产术前30 min静脉使用抗生素能显著降低术后病率的发生,且一次性用药即可,无需对低感染风险的剖宫产产妇在术后重复应用抗生素预防感染.

abstractsObjectlve To investigate the effect of prophylactic antibiotics in peri-cesarean section(CS) for pregnant women with low risk of infection and the best regimen of prophylactic antibiotics. Methods A prospective randomized controlled trial was conducted on 720 pregnant women with low risk of infection,who underwent lower segment CS at the Affiliated Drum Tower Hospital of Nanjing University Meditsl School from November 2007 to October 2008.All subiects were randomized into four groups and different regimens of prophylactic antibiotics were given. Intravenous ceftizoxime sodium or clindamycin were selected.Group A included 176 gravidas without any antibiotics in peri-CS period;Group B were 190 gravidas who received a single dose of antibiotics within 30 min before CS;Group C consisted of 180 women receiving a single dose of antibiotics within 30 min before CS and another two doses after CS once daily;Group D were 174 women received antibiotics only after CS for five consecutive days once daily.The duration of temperature recovery to norrnal after the operation,postoperative morbidity,postoperative infection rate and postoperative hospital stay in the four groups were recorded and compared.Variance analysis,Chi-square test and Fisher's exact test were performed. Results The overall postoperative infection rate and postoperative morbidity were 0.83%(6/720)and 4.58 0A(33/720).respectively,and no significant difference was found in the postoperative infection rate among the 4 groups(P>0.05).The duration of temperature recovery to normal and postoperative hospital stay were shorter in group B[(41.9± 31.6)h and(4.8±1.1)d3 than in group A[(67.0±40.6)h and(5.7±1.O)d3 and group D [(70.1±39.9)h,(5.9±1.1)d,all P<0.01],and similar results were obtained when comparing those in group C[(41.1±36.5)h and(4.7±O.9)d] with group A and D.The postoperative morbidity in group B[1.05%(2/190)]was also significantly lower than that in group A [7.39%(13/176)]and D [9.20%(16/174)](all P<0.01),and it was the same when comparing this number of group C [1.11%(2/180)]with that of group A and D.However,significant difference was detected neither between group B and C,nor between group A and D in any of the 4 indicators. Conclusions Single dose of antibiotics intravenously within 30 rain before CS can significantly reduce the incidence of postoperative morbidity in pregnant women with low risk of infection.Repeated dose of antibiotics is unnecessary for the purpose of infection prevention for CS in patients with low risk of infection.