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[1]李翰林,童培建.利福平聯(lián)合用藥配合保留假體清創(chuàng)治療 人工關(guān)節(jié)置換術(shù)后早期感染及低毒性感染[J].中醫(yī)正骨,2015,27(09):56-58.
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利福平聯(lián)合用藥配合保留假體清創(chuàng)治療 人工關(guān)節(jié)置換術(shù)后早期感染及低毒性感染()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第27卷
期數(shù):
2015年09期
頁碼:
56-58
欄目:
臨床報(bào)道
出版日期:
2015-09-30

文章信息/Info

作者:
李翰林1; 童培建2
1.江蘇省蘇州市吳江區(qū)中醫(yī)醫(yī)院/江蘇省蘇州市吳江區(qū)第二人民醫(yī)院,江蘇 蘇州 215221;
2.浙江省中醫(yī)院,浙江 杭州 310006
關(guān)鍵詞:
關(guān)節(jié)成形術(shù); 置換;  手術(shù)后并發(fā)癥;  感染;  清創(chuàng)術(shù);  利福平;  氧氟沙星;  夫西地酸鈉
摘要:
目的:探討利福平聯(lián)合左氧氟沙星或夫西地酸鈉口服配合保留假體清創(chuàng)治療人工關(guān)節(jié)置換術(shù)后早期感染及低毒性感染的臨床療效和安全性。方法:2007年10月至2013年10月收治19例人工關(guān)節(jié)置換術(shù)后早期感染及低毒性感染患者。男8例,女11例; 年齡61～85歲,中位數(shù)65歲; 全髖關(guān)節(jié)置換術(shù)后感染7例,全膝關(guān)節(jié)置換術(shù)后感染12例。人工關(guān)節(jié)置換術(shù)至出現(xiàn)感染癥狀或體征的時(shí)間為3 d至3個(gè)月,中位數(shù)18 d。對(duì)3例竇道形成及4例有急性感染表現(xiàn)的患者先保留假體清創(chuàng),靜脈滴注圍手術(shù)期未使用過的對(duì)致病菌敏感的抗生素1周,然后按照藥敏結(jié)果采用利福平600 mg聯(lián)合左氧氟沙星500 mg口服或者利福平600 mg聯(lián)合夫西地酸鈉500 mg口服,每天1次,持續(xù)6個(gè)月。其余12例根據(jù)藥敏結(jié)果先采用利福平聯(lián)合用藥治療,若病情控制不佳則清創(chuàng)保留假體,再采用利福平聯(lián)合用藥。治療結(jié)束后定期隨訪,觀察患者的肝腎功能、血象、血沉、C反應(yīng)蛋白、關(guān)節(jié)活動(dòng)度、關(guān)節(jié)功能及關(guān)節(jié)局部狀況。以臨床感染癥狀和體征消失或減輕,血沉<20 mm·h-1、C反應(yīng)蛋白<5 mg·L-1或治療后顯著降低且趨于正常,關(guān)節(jié)疼痛減輕或消失,關(guān)節(jié)活動(dòng)度良好作為治愈標(biāo)準(zhǔn)。結(jié)果:1例患者治療過程中出現(xiàn)假體松動(dòng),行假體置換治療; 其余18例患者完成6個(gè)月的治療,其中4例治療開始后出現(xiàn)輕微惡心、腹瀉、皮疹等表現(xiàn),但堅(jiān)持用藥6個(gè)月。所有患者均獲隨訪,時(shí)間12～36個(gè)月,中位數(shù)18個(gè)月。保留假體清創(chuàng)后行利福平聯(lián)合用藥治療的7例患者,服藥6個(gè)月后治愈。12例先行利福平聯(lián)合用藥治療的患者中,3例服藥6個(gè)月后治愈; 1例出現(xiàn)假體松動(dòng),行關(guān)節(jié)置換術(shù)后治愈; 8例感染控制不佳,使用抗生素后疼痛緩解,但皮溫仍然升高,行保留假體清創(chuàng),然后再采用利福平聯(lián)合用藥治療,服藥6個(gè)月后5例治愈,3例治療失敗。結(jié)論:利福平聯(lián)合左氧氟沙星或夫西地酸鈉口服配合保留假體清創(chuàng),對(duì)于人工關(guān)節(jié)術(shù)后早期感染或低毒性感染具有較好的臨床療效和較高的安全性,在診斷明確、適應(yīng)證適宜的情況下可作為首選治療方法。

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備注/Memo

備注/Memo:
2015-05-22收稿 2015-06-19修回
更新日期/Last Update: 2015-09-30