【摘 要】
：
目的:探讨头孢菌素联合吗啉硝唑预防肠外瘘病人手术部位感染（SSI）的临床价值。方法:采用回顾性队列研究方法。收集2017年1―12月中国人民解放军东部战区总医院收治的107例行择期消化道重建手术肠外瘘病人的临床病理资料；男76例，女31例；中位年龄为46岁，年龄范围为18~79岁。107例病人中，43例病人给予头孢菌素预防SSI，设为头孢菌素单药组；64例病人给予头孢菌素联合吗啉硝唑预防SSI，设为联合用药组。观察指标：（1）SSI发生情况。（2）分层分析。（3）SSI致病菌培养结果。（4）药物不良反应发
【机 构】
：
南京医科大学附属明基医院普通外科 210019;中国人民解放军东部战区总医院全军普通外科研究所，南京 210002
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目的:探讨头孢菌素联合吗啉硝唑预防肠外瘘病人手术部位感染（SSI）的临床价值。方法:采用回顾性队列研究方法。收集2017年1―12月中国人民解放军东部战区总医院收治的107例行择期消化道重建手术肠外瘘病人的临床病理资料；男76例，女31例；中位年龄为46岁，年龄范围为18~79岁。107例病人中，43例病人给予头孢菌素预防SSI，设为头孢菌素单药组；64例病人给予头孢菌素联合吗啉硝唑预防SSI，设为联合用药组。观察指标：（1）SSI发生情况。（2）分层分析。（3）SSI致病菌培养结果。（4）药物不良反应发生情况。（5）随访情况。采用门诊和电话方式进行随访，了解病人其他并发症发生情况。正态分布的计量资料以n x±s表示，组间比较采用独立样本n t检验；偏态分布的计量资料以n M（范围）表示，组间比较采用Mann-Whitney n U检验。计数资料以绝对数或百分比表示，组间比较采用n χ2检验或Fisher确切概率法。n 结果:（1）SSI发生情况：107例病人中，29例发生SSI，其中浅层切口感染15例、深层切口感染7例、器官和（或）腔隙感染7例。头孢菌素单药组病人发生总体SSI、浅层切口感染、深层切口感染、器官和（或）腔隙感染的例数分别为18、7、5、6例，联合用药组上述指标分别为11、8、2、1例，两组病人总体SSI比较，差异有统计学意义（n χ2n =7.925，n P0.05）。（2）分层分析：43例头孢菌素单药组病人中，Ⅱ类切口10例、Ⅲ类切口33例；64例联合用药组病人中，上述指标分别为11、53例。在Ⅱ类切口中，头孢菌素单药组病人发生SSI 1例，联合用药组2例，两组比较，差异无统计学意义（n P>0.05）。在Ⅲ类切口中，头孢菌素单药组病人发生SSI 17例，联合用药组9例，两组比较，差异有统计学意（n χ2n =11.499，n P0.05). (2) Stratification: there were 10 cases and 33 cases with type Ⅱ incision and type Ⅲ incision in the 43 cases of cephalosporin monotherapy therapy group, respectively. The above indicators were 11 and 53 in the combination group, respectively. For the type Ⅱ incision, 1 patient of cephalosporin monotherapy group had SSI, and 2 cases of combination therapy group had SSI, showing no significant difference between the two groups (n P>0.05). For the type Ⅲ incision, 17 patient of cephalosporin monotherapy group had SSI, and 9 cases of combina-tion therapy group had SSI, showing a significant difference between the two groups (n χ2=11.499, n P<0.05). (3) Pathogen culture results of SSI: of 29 patients with SSI, 21 were positive for bacterial culture, including 12 cases with single bacterial infection, 9 cases with mixed infection of multi-bacteria. A total of 33 strains were cultured. (4) Adverse drug reaction: there was no adverse drug reaction in the 107 patients. (5) Follow-up: 107 patients were followed up for 30 days after surgery. No complication occurred in the 107 patients.n Conclusion:Cephalosporin combined with morini-dazole can be used to prevent the SSI for patients with gastrointestinal fistula.
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