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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。
Objective To investigate the effect of prophylactic use of antibacterials during perioperative cesarean section on the control of surgical site infection and endometritis. Methods The relevant medical literature database was searched to collect, screen, evaluate and extract the data for meta-analysis of the clinical randomized controlled trials of antibacterial drugs for prevention of surgical site infection in cesarean section. Results The meta-analysis showed that short-term antibiotics were given 0.5 to 2 hours preoperatively or after umbilical cord clamping for long-term use of antimicrobial agents to prevent surgical site infection (OR = 0.34, 95% CI 0.24-0.48, P < 0.05) and postnatal morbidity (OR = 0.40, 95% CI 0.32-0.48, P <0.05). The differences in the efficacy of the above two strategies were not only in the prevention of simple selective cesarean section (OR = 0.45 , 95% CI 0.11-1.83, P> 0.05) or in the postoperative endometritis in the selective / non-selective cesarean section (OR = 0.55,95% CI 0.16-1.96, P> 0.05) No statistical significance. Conclusions Short-term use of antibacterials 0.5 to 2 hours preoperatively or after umbilical cord clamping is recommended as a strategy to prevent caesarean section-related infections.