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目的:探索剖宫产预防用抗菌药物的最佳时机,为降低剖宫产后感染率,合理使用抗菌药物提供研究证据。方法:纳入138例择期剖宫产患者,随机分为试验组(A)和对照组(B)。试验组切皮前0.5~2 h静脉滴注头孢硫脒2.0g,术后6 h内再静脉滴注头孢硫脒2.0g。对照组断脐后立即给予头孢硫脒,术后6 h内再静脉滴注头孢硫脒2.0g,比较2组产妇术后并发症、对新生儿的影响的差异。结果:2组患者手术时间,术中失血量,术后6、12、24、48 h体温,术后48 h白细胞、中性粒细胞,差异没有统计学意义。对照组夹闭脐带后静脉滴注头孢硫脒,抗菌药物预防时间短于试验组,P<0.05,2组患者比较有统计学意义,但没有显示出对产妇/新生儿的影响。2组出院时均无一例发生子宫内膜炎、伤口感染、症状性尿路感染,出院后随访2周和6周也未发现患者再次感染。试验期间,5例产妇发生产褥病率,2例在试验组,3例在对照组,差异无统计学意义。NICU立即入院率、新生儿败血症发生率、新生儿败血症标本送检率,差异没有统计学意义。新生儿大便菌群失调主要表现为Ⅰ、Ⅲ度,但经统计学处理,没有显著性差异。结论:仅依据本中心的数据,足月孕择期剖宫产,不合并胎盘早剥、胎膜早破、前置胎盘等感染风险因素,未显示出预防用抗菌药物时机对产妇/新生儿的影响。
OBJECTIVE: To explore the optimal timing of antimicrobial agents for preventing cesarean section and to provide evidence for rational use of antimicrobial agents in order to reduce post-cesarean section infection rate. Methods: 138 cases of elective cesarean section were enrolled and randomly divided into experimental group (A) and control group (B). The experimental group 0.5-2 h before cephalosporin cefathiamidine intravenous infusion of 2.0g, within 6 h after intravenous cefathiamidine 2.0g. In the control group, cefathiamidine was given immediately after the umbilical cord was cut off, and cefathiamidine 2.0 g was intravenously injected within 6 hours after operation. The differences in postoperative complications between the two groups of mothers were compared. Results: There was no significant difference in the operation time, intraoperative blood loss, body temperature at 6, 12, 24 and 48 h after operation, and leukocyte and neutrophil at 48 h after operation. The control group received intravenous cefathiamidine after clipping the umbilical cord, and the preventive time of antimicrobial agents was shorter than that of the test group. P <0.05. The patients in the two groups were statistically significant, but the effect on maternal / newborn infants was not shown. Neither endometritis, wound infection nor symptomatic urinary tract infection were found in either group at discharge, and no recurrence was found after 2 and 6 weeks follow-up in hospital. During the trial, 5 cases of puerperal morbidity, 2 cases in the test group, 3 cases in the control group, the difference was not statistically significant. NICU immediate admission rate, the incidence of neonatal sepsis, neonatal sepsis specimens submitted rate, the difference was not statistically significant. Neonatal stool flora mainly manifested as Ⅰ, Ⅲ degree, but by statistical analysis, there was no significant difference. Conclusion: According to the data of our center, risk factors of cesarean section, full-term pregnancy with unexplained cesarean section, premature rupture of membranes, placenta previa and other risk factors of infection did not show the effect of prophylactic antimicrobial agents on maternal / newborn influences.