在手术期间的伤口灌以预防手术部位感染:系统性审查和元分析
Kaique Flavio Xavier Cardoso Filardi1, Gustavo Roberto Minetto Wegner2, Arnaldo Bastos Dos Santos3
1Department of Surgery, Division of Digestive Surgery, University of São Paulo, São Paulo, Brazil.
World journal of surgery
|September 11, 2024
概括
在腹部手术中,使用抗微生物或杀菌剂的手术内伤口灌显著减少了手术部位感染 (SSI). 在各种手术和伤口类型中观察到这种益处,尽管研究异质性需要考虑.
科学领域:
- 手术感染预防 手术感染预防
- 基于证据的医学 基于证据的医学
- 进行元分析分析.
背景情况:
- 手术部位感染 (SSI) 仍然是腹部手术的一个重要问题.
- 用抗微生物药物 (AMA) 或抗菌剂 (ASA) 进行手术内伤口灌 (IOWI) 的有效性在SSI预防方面受到争议.
- 目前关于IOWI与AMA/ASA的指导方针尚未普遍确立.
研究的目的:
- 系统地审查和分析随机临床试验 (RCT),评估IOWI与AMA或ASA的有效性与盐水相比,在腹部手术后预防SSI.
- 评估IOWI在不同外科手术环境中对SSI率的影响,包括手术类型,干预剂和伤口分类.
主要方法:
- 系统性审查和RCT的元分析.
- 包括的研究比较了腹部手术患者的AMA或ASA用盐溶液灌.
- 根据手术类型,干预剂和伤口分类进行了分分析.
主要成果:
- 分析了19项涉及4915名患者的研究.
- 使用AMA或ASA的IOWI显著降低了SSI率 (OR0.62;95%CI为0.47-0.82).
- 特别是在急诊手术和受污染的伤口中注意到SSI率的降低,AMA和ASA都显示了好处.
结论:
- 用抗微生物或杀菌剂进行手术内伤口灌与腹部手术后手术部位感染的显著减少有关.
- 亚组分析表明持续的好处,特别是在更高风险的场景,如紧急程序和受污染的伤口.
- 虽然这些发现是有希望的,但包含的研究中的异质性需要谨慎的解释.
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