中国实用外科杂志

中国实用外科杂志

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世界卫生组织手术部位感染预防指南介绍

吴秀文，任建安，黎介寿   

  1. 南京军区南京总医院  解放军普通外科研究所 南京大学医学院临床学院，江苏南京 210002
  • 出版日期:2016-02-01 发布日期:2016-01-29

  • Online:2016-02-01 Published:2016-01-29

摘要：

世界卫生组织“病人安全”项目于2012年开始启动全球性手术部位感染（SSI）预防指南的制定工作，并将于2016年正式出版。该指南在以下几方面进行了更新：（1）术前沐浴以降低SSI发生率仅是临床规范，并无循证医学证据支持，不推荐术前使用洗必泰擦拭巾。（2）推荐手术部位消毒使用含碘伏或氯己定的酒精类消毒液。（3）推荐在切皮前120 min内预防性应用抗生素，但同时须考虑抗生素半衰期。（4）推荐全麻气管插管的结直肠手术成年病人术中和术后2～6 h吸入80%浓度的氧气。（5）不建议术中施行目标导向性液体治疗或限制性液体治疗以降低SSI发生率。（6）建议对清洁-污染切口和污染切口的腹部手术使用伤口保护套减少SSI发生。

关键词: 手术部位感染, 指南, 世界卫生组织

Abstract:

Interpretation of the prevention guideline on surgical site infections from World Health Organization        WU Xiu-wen，REN Jian-an，LI Jie-shou. Research Institute of General Surgery，Jinling Hospital，Medical School of Nanjing University，Nanjing 210002，China
Corresponding author：REN Jian-an，E-mail：jan@medmail.com.cn
Abstract    The “Patient Safety”project from World Health Organization started the formulation of global surgical site infection (SSI) prevention guideline at 2012，which will be published，extended，and implemented at 2016. Several aspects were revised，including：(1) It is good clinical practice for patients to bath or shower prior to surgery. Chlorhexidine gluconate (CHG) cloths should not be used for the purpose of reducing SSI. (2) Alcohol-based antiseptic solutions containing either an iodophor or CHG are recommended for surgical site preparation on skin in patients undergoing surgical procedures. (3) Surgical antibiotic prophylaxis should be administered within 120 min before incision while considering the half-life of the antibiotic. (4) Adult patients undergoing general anesthesia with endotracheal intubation for surgical procedures should receive 80% of oxygen intra-operatively and if feasible, in the immediate postoperative period for 2-6 h. (5) The goal directed fluid therapy or restrictive fluid management strategies were not suggested intraoperatively specifically for the purpose of the reduction of SSI. (6) The use of wound protector devices in clean-contaminated，contaminated，and dirty abdominal surgical procedures was suggested for the purpose of reducing the rate of SSI.

Key words: surgical site infection, guideline, World Health Organization