2019 年第 10 期 第 14 卷

头孢西丁不同输注方案预防复杂性肛瘘术后感染临床效果的对比研究

Clinical efficacy of different infusion regimens of cefoxitin in preventing postoperative infection of complex anal fistula

作者：肖衡谭立新陈荣叶亮

英文作者：

单位：412007中南大学湘雅医学院附属株洲市中心医院肛肠外科

英文单位：

关键词：肛瘘；头孢西丁；输注时间；感染

英文关键词：

• 摘要：

• 【摘要】目的    研究头孢西丁不同输注方案预防复杂性肛瘘术后感染的临床效果。方法    选取2016年 3月至2018年3月中南大学湘雅医学院附属株洲市中心医院接受括约肌间瘘管结扎术（LIFT）治疗的复杂性肛瘘患者120例作为研究对象，采用随机数字表法分为观察组和对照组，每组60例。2组患者均接受LIFT，观察组在术前0.5 h时开始静脉滴注头孢西丁1.0 g，并在术后6 h开始静脉滴注头孢西丁，1.0 g/次，3次/d。对照组在术前1 h静脉滴注头孢西丁1.0 g，并在术后4 h开始静脉滴注头孢西丁，1.0 g/次，3次/d。比较2组手术效果，记录患者术后康复情况，记录术后感染和药物不良反应发生率。比较用药第2天谷时微量血清杀菌活性（SBA）。结果    观察组显效率高于对照组，但差异无统计学意义（χ2=2.596，P=0.107）。观察组术后住院时间和创面愈合时间明显短于对照组，切口愈合不良发生率明显低于对照组［（3.4±1.6）d比（4.5±1.8）d、（21±5）d比（24±5）d、3.3%（2/60）比15.0%（9/60）］，差异均有统计学意义（均P＜0.05）。观察组术后感染发生率明显低于对照组［3.3%（2/60）比13.3%（8/60）］，差异有统计学意义（χ2=3.927，P=0.048）。2组出院时Wexner评分和药物不良反应发生率差异均无统计学意义（均P＞0.05）。观察组谷时SBA效价高于对照组［（1.18±0.27）比（1.06±0.25）］，差异有统计学意义（t=2.526，P=0.013）。结论    复杂性肛瘘患者LIFT后缩短头孢西丁用药间隔时间，增加整体用药剂量有助于提高抗菌效果，降低术后感染风险，促进患者术后早期康复。

• 【Abstract】Objective    To investigate the clinical efficacy of different infusion regimens of cefoxitin in preventing postoperative infection of complex anal fistula. Methods    A total of 120 patients with complex anal fistula undergoing ligation of intersphincteric fistula tract（LIFT） in Zhuzhou Central Hospital, Xiangya School of Medicine, Central South University from March 2016 to March 2018 were randomly divided into observation group and control group, with 60 cases in each group. The observation group had intravenous infusion of cefoxitin 1.0 g at 0.5 h before operation and cefoxitin 1.0 g/time, 3 times/d since 6 h after operation. The control group had intravenous infusion of cefoxitin 1.0 g at 1 h before operation and cefoxitin 1.0 g/time, 3 times/d since 4 h after operation. Surgical effect was evaluated. Postoperative rehabilitation, infection and adverse drug reactions were observed. Serum bactericidal activity (SBA) was tested on the 2nd day after drug administration. Results    The effective rate in observation group was higher than that in control group but no statistical difference was noticed（χ2=2.596, P=0.107）. Postoperative hospital stay time and wound healing time in observation group were significantly shorter and the incidence of poor wound healing was significantly lower than those in control group［（3.4±1.6）d vs （4.5±1.8）d, （21±5）d vs （24±5）d, 3.3%（2/60） vs 15.0%（9/60）］(all P<0.05). The incidence of postoperative infection in observation group was significantly lower than that in control group［3.3%(2/60) vs 13.3%(8/60)］（χ2=3.927, P=0.048）. There were no significant differences of Wexner score at discharge and the incidence of adverse drug reactions between groups(all P>0.05). Trough SBA in observation group was significantly higher than that in control group［（1.18±0.27） vs （1.06±0.25）］(t=2.526, P=0.013). Conclusion    High dose of cefoxitin with short administration interval can improve the antibacterial effect on patients with complex anal fistula undergoing LIFT, reduce the risk of postoperative infection and promote recovery.