围手术期抗菌药物的预防性应用 解放军总医院第一附属医院 黎沾良

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围手术期抗菌药物的预防性应用 解放军总医院第一附属医院 黎沾良. 外科医生的困惑 ★ 围手术期应用抗生素是预防哪些感染? ★ 什么情况下需要预防用抗生素? ★ 怎样选择预防用抗生素? ★ 什么时候开始用药? ★ 抗生素要用多长时间?. 围手术期预防性应用抗菌药物的目的. ★ 是预防 手术部位感染 ( surgical site infection, SSI ) ,指发生在切口或手术深部器官或腔隙的感染 ★ SSI 的概念比切口感染宽,但比术后感染窄 ★ SSI 约占全部医院感染的 15% ★ 约占外科病人医院感染的 35%  40%. - PowerPoint PPT Presentation

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  • surgical site infection, SSI) SSI SSI15%35%40%

  • SSI*,SSI

    dCruse198010$ 2000Martone19927.2$ 3152 199817.82 3232200210 3368200315 1176*

  • SSI

  • 30 1 2 3 4SSI

  • 301 1. 2.> 383. 4.

  • 301 1. 2. 3. 4.

  • /

  • SSI 19861996593344SSI 155232.62% 19972001, 152747343151SSI4.22%SSI

  • SSI

    SSI(%)a109364564.240563187.82642911.01201512.58222.4

  • 6466610.27116919.771271722.429781234.1128419014.8267818303.1133522591.9

  • SSI

    SSISSI%/a45668.425.85.831878.316.94.82971.421.47.11553.313.333.32100.000

  • 6652.335.412.369158.426.315.317278.813.57.612379.712.28.119069.028.92.183073.616.99.525977.914.27.9

  • /1/3 SSI77%90%/[Infect Control and Hosp Epidemiol, 1999,20(4):247-280]

  • 1

  • 2

  • (>3h)/3

  • SSI3

  • SSI

    1

    6

    11

    17

    24

    0

    1

    2

    3

    Sheet1

    6111724

    Sheet1

    0

    0

    0

    0

    Sheet2

    Sheet3

  • SSI12013

    2

    3.2

    5.2

    7.3

    11.1

    1

    Sheet1

    3.25.27.311.1

    Sheet1

    0

    0

    0

    0

    Sheet2

    Sheet3

  • -

  • (- + =

  • Cruse 1% -7% 20% -40%

  • -

  • GUIDELINESIGNScottish Intercollegiate Guideline Network

  • GUIDELINESIGNScottish Intercollegiate Guideline Network

  • 4

  • G+G-

  • G+G-MRSASSI

  • --(//)4

  • SSI

  • ; +

  • B +

  • SSI G-G+

  • 30 min(2h)> MIC 9013

  • 30 min-12 hh;()

  • SSIScher 801-3hr1Am Surg,1997,63:59

    ###1g iv, 1g iv, 21g iv, 3hr6.1%*1.3%1.3%*p

  • 24hKager 13 3

  • 248Dellinger. Arch Surg,1988,123:3395 P>0.05

    14%514%511%

  • 1310.84%3/35832.68%10/373[ 2000]

  • 2004[ Clin Infect Dis, 2004,38(12): 1706-1715 ]124

  • 124h,48h(35d)

  • ()24hFabian280 < 3 h11235 1 8%14%510%15%

  • 24 h4872 h

  • PMMA-

  • 2%1235d,45d

  • 2007118

  • 3557348598.0% I96.9% 98.9% 99.6%

  • 3-2115.9%

  • 56.6%

  • 52.2%17.4%21.72.430.4%2

  • 35577.47.610.55.75.88.1

  • 1354 -11.22.4g, 8g, 6g15.6%