抗菌药物预防剖宫产手术部位感染国内文献荟萃分析

目的 探讨剖宫产围手术期预防性使用抗菌药物策略对控制其手术部位感染和子宫内膜炎的影响。方法检索相关医学文献数据库，对抗菌药物预防剖宫产手术部位感染的临床随机对照研究进行收集、筛选、评价并提取数据进行荟萃分析。结果荟萃分析表明，首剂术前0．5～2h或钳夹脐带后给予短期抗菌药物较术后长期使用抗菌药物预防剖宫产手术部位感染（OR=0．34，95％CI为0．24～0．48，P％0．05）和产后病率（OR：0．40，95％CI为0．32～0．48，P％0．05）的效果显著；对上述2种用药策略效果差异无论是在预防单纯选择性剖宫产术（OR=0．45，95％CI为0．11～1．83，P〉0．05）或是在选择／非选择性剖宫产术（OR=0．55，95％CI为0．16～1．96，P〉0．05）术后子宫内膜炎方面均无统计学意义。结论推荐术前0．5～2h或钳夹脐带后短期使用抗菌药物作为预防剖宫产手术相关感染的一项策略。

The prophylactic antimicrobial application for preventing surgical site infection of cesarean section: A Meta analysis

Objective To evaluate the impact of prophylactic administration of antimicrobials in cesarean section on controlling surgical site infection （SSI） and postpartum endometritis. Methods Comprehensive Chinese randomized controlled trials retrieval about preventing postpartum infection related to cesarean section by antimicrobial prophylactic use was performed via searching electronic database, hand searching bibliographies of books and relevant journals. Results Compared with long-term antimicrobial prophylaxis started after operation, short-term anti- microbial prophylaxis started 0. 5-2 hours before operation or started after clamping of umbilical cord showed lower SSI rate （OR = 0. 34,95 %CI 0. 24-0. 48 ,P〈0. 05） and puerperal morbidity （OR = 0. 40,95 %CI 0. 32-0. 48 ,P〈 0. 05）, and there was no significant difference in lowering postpartum endometritis incidence between selective cesarean-section （OR = 0. 45,95 % CI 0. 11- 1.83, P〉0. 05） and selective/unselective cesarean-section （OR = 0. 55, 95%CI O. 16-1.96,P〉0. 05）. Conclusion Short-term antimicrobial prophylaxis started 0. 5 to 2 hours before operation or after clamping of umbilical cord is a recommendable strategy for preventing SSI and puerperal morbidity.