摘要
目的分析择期行腹腔镜胆囊切除术(LC)的老年患者(年龄≥65岁)围手术期不预防性使用抗生素的可行性和经济性。方法采用回顾性、同期临床对照研究,将158例LC患者按围手术期是否预防用药分组,未用抗生素的89例为A组,使用抗生素的69例为B组。通过独立样本t检验,比较2组患者基本信息、医疗情况、医疗费用等指标的差异。结果与B组相比,A组在未预防用抗生素的情况下,患者术后住院时间明显缩短(2. 9±1. 4 vs.3. 6±1. 2) d、药品花费显著减少(1 701. 7±554. 7 vs. 1 894. 6±581. 1)元、医保结算达标率显著提高(83. 15%vs.37. 68%),差异均有统计学意义(P <0. 05)。但2组术后切口均甲级愈合,未发生感染,治愈情况差异无统计学意义(P> 0. 05)。结论≥65岁老年患者,即使合并糖尿病或心脑血管疾病等部分高危因素,择期LC围手术期不预防性使用抗生素是安全、可行的,但仍需临床大样本对照研究加以验证。
Objective To analyze the feasibility and economics of non-preventive use of antibiotics in elderly patients( age 65 years or older) undergoing laparoscopic cholecystectomy( LC). Methods A retrospective,concurrent clinical control study was used to group 158 patients with LC according to whether they had taken preventive medication during the perioperative period. Among them,89 patients without antibiotics were used as group A,and 69 patients with antibiotics were used as group B. The statistical differences of the basic information,medical conditions,and medical costs of the two groups of patients were compared. Results Compared with group B,in the case of group A without prophylactic antibiotics,the postoperative hospital stay was significantly shorter( 2. 9 ± 1. 4 vs. 3. 6 ± 1. 2) days,and the drug cost was significantly reduced( 1 701. 7 ± 554. 7 vs. 1 894. 6 ± 581. 1) The rate of compliance with medical insurance settlements increased significantly( 83. 15% vs. 37. 68%),and the differences were statistically significant( P < 0. 05). However,the postoperative incisions of the two groups were all healed with grade A,no infection occurred,and there was no significant difference in the healing status( P > 0. 05). Conclusion Elderly patients≥65 years of age,even if combined with some high-risk factors such as diabetes or cardiovascular and cerebrovascular diseases,elective LC perioperative non-preventive use of antibiotics is safe and feasible,but it needs to be verified by clinical large-scale controlled studies.
作者
殷卫清
唐叶秋
归莱
范红春
YIN Weiqing;TANG Qiuye;GUI Lai(Changshu First People's Hospital/Changshu Hospital Affiliated to Suzhou University,Jiangsu Province,Changshu City 215500,China)
出处
《临床合理用药杂志》
2019年第35期8-10,共3页
Chinese Journal of Clinical Rational Drug Use
基金
江苏省卫计委面上项目(H2018071)
关键词
择期腹腔镜胆囊切除术
围手术期
预防性抗生素
老年患者
Selective laparoscopic cholecystectomy
Perioperative period
Prophylactic antibiotics
Elderly patients
