永久起搏器围手术期阿莫西林舒巴坦与头孢呋辛预防感染效果比较

目的：探讨不同的抗生素在永久起搏器围手术期预防感染中的效果及安全性，为临床选择合理的抗生素提供依据。方法：将2015年8月至2017年8月温州市中心医院就诊的植入永久起搏器的患者共120例，按照随机数表法分为观察组和对照组，每组均为60例；观察组术前0.5 h采用阿莫西林舒巴坦（1.5 g静脉滴注），术后24 h内停用，对照组使用头孢呋辛（1.5 g静脉滴注）预防感染，使用方法与观察组相同；在术前、术后48、72 h均比较2组临床特征，比较2组患者手术后7 d感染发生情况，检测2组病原菌种类，比较2组住院情况和不良反应发生率。结果：2组患者术前体温、白细胞（WBC）、C-反应蛋白（CRP）、降钙素原（PCT）差异均无统计学意义（P＞0.05）；而术后48、72 h观察组体温、WBC、CRP、PCT显著低于对照组（P＜0.05）；7 d内发热发生率观察组低于对照组（P＜0.05）；观察组起搏器囊袋感染的发生率低于对照组（P＜0.05）；2组囊袋血肿、肺部感染及感染性心内膜炎发生率差异均无统计学意义（P＞0.05）；而且对照组出现严重感染需拔除起搏器及电极1例，观察组未出现；2组起搏器感染的病原菌最常见的为金黄色葡萄球菌，对照组培养出表皮葡萄球菌、大肠埃希菌、肺炎克雷伯杆菌，而观察组未见；2组的不良反应发生率差异无统计学意义（P＞0.05）；观察组抗生素成本少于对照组（P＜0.05）。结论：阿莫西林舒巴坦在永久起搏器植入术围手术期预防感染效果优于头孢呋辛，感染发生率较低，而不良反应与头孢呋辛相当，且费用低廉。

A comparative study of amoxicillin sulbactam and cefuroxime in the prevention of infection during periop-erative period of permanent pacemaker

Objective: To investigate the effectiveress and safety of different antibiotics in the prevention of infection during perioperative period of permanent pacemaker, for the sake of reasonable selection of antibiotics in clinical practice. Methods: From August 2015 to August 2017, 120 patients with permanent pacemaker implantation in Wenzhou Central Hospital were randomly divided as experimental group and control group, each group consisting of 60 patients. Amoxicillin sulbactam (1.5 g intravenous drip) was used half an hour before operation in experimental group, and cefuroxime (1.5 g intravenous drip) was used in control group to prevent infection within 24 hours after operation. In both groups, body temperature, white blood cell (WBC), C-reactive protein (CRP) and procalcitonin (PCT) were measured before operation, 48 hours and 72 hours after operation and the indexes were compared between the two groups. The incidence of fever, pacemaker bag infection, bag hematoma, pulmonary infection, infective endocarditis, pathogens, adverse reactions of antibiotics and cost of antibiotic were compared within 7 days after operation. Results: There was no significant difference in body temperature, WBC, CRP and PCT between the two groups before operation (P>0.05). The body temperature, WBC, CRP and PCT of the experimental group at 48 and 72 hours after operation were significantly lower than those of the control group (P<0.05). The incidence of fever within 7 days in the experimental group was lower than that of the control group (1.67% vs. 11.67%, P<0.05). The incidence of pacemaker bag infection in the experimental group was lower than that in the control group (3.33% vs. 13.33%, P<0.05). The incidence of pocket hematoma, pulmonary infection and infectious endocarditis was not significantly different between the two groups (P>0.05). In the control group, 1 case of severe infection required removal of pacemaker and electrodes, but none in the experimental group. Staphylococcus aureus was the most common pathogen of pacemaker infection in the two groups, while Staphylococcus epidermidis, Escherichia coli and Klebsiella pneumoniae were cultured in the control group. No adverse reactions were found in the experimental group. There was no significant difference between the two groups (P>0.05). The cost of antibiotics in the experimental group was less than that in the control group (P<0.05). Conclusion: Amoxicillin sulbactam is superior to cefuroxime in the prevention of infection during perioperative period of permanent pacemaker implantation with lower incidence of infection, less cost and comparable adverse reactions to cefuroxime.