骨科手术预防性应用抗生素的合理性与时机

骨科一类手术一般情况下没有必要应用抗生素预防感染。对于手术时间较长、内置物较多等情况,可于手术前酌情应用抗生素;较大的或污染较重的开放伤口均应预防性应用抗生素。抗生素应针对可能感染的病原菌是革兰氏阳性菌还是革兰氏阴性菌抑或是厌氧菌进行选择,并且要用足量。术前提前一天甚至几天及术后超过36小时应用抗生素是没有根据的,术后根据患者血象和体温来决定是否停用抗生素也是不科学的。抗生素的预防性应用必须掌握用药指征、药物的针对性和剂量及用药时机,方能达到预期效果。

THE RATIONALITY AND OCCASION OF ANTIBIOTICS PREVENTIVE APPLICATION IN ORTHOPAEDICS OPERATIONS

It is unnecessary to use antibiotics to prevent infection in orthopaedics operations under common condi tions. But if the operation will take rather long time or there will be more substance remained in it pre-operation prescrip tion of antibiotics may be considered. In case of larger or opened worse polluted wound antibiotics must usually be used to prevent infection. Selection of antibiotics must aim at different polluted pathogenic germs, grams positive, grams negative, or anaerobe; furthermore, the quantity must sufficient. There is a lack of evidence to use antibiotics one day even several days before operation or 36 hours after operation. It is not scientific to stop antibiotics according to patient's hemogram and temperature. Antibiotics must be preventively used in control of indication, pertinence, dosage and occasion of drugs so that expect effect will be achieved.