围手术期预防手术部位感染：切口备皮应该怎么做？预防性抗生素要在哪个时间窗内给完？
For preventing surgical site infection, how should preoperative hair removal at the incision site be done, and by what time window must prophylactic antibiotics be fully infused?
切口部位毛发最好不去除；确需去除时应用剪刀或电动剪毛器而非剃刀，因为剃刀造成的微小皮肤划伤会增加细菌定植与手术部位感染的风险。预防性抗生素应在切皮前60分钟内静脉输注完毕，使整个手术期间组织药物浓度保持有效水平；万古霉素、氟喹诺酮类等需缓慢输注的药物应提前开始。
Hair at the operative site should ideally be left in place; when removal is unavoidable, clippers or scissors are used rather than razors, because razor microabrasions promote bacterial colonization and raise surgical-site-infection rates. Prophylactic antibiotics must finish infusing within 60 minutes before incision so effective tissue levels persist throughout surgery; slower-infusing agents such as vancomycin or fluoroquinolones need to be started earlier.
难度 进阶 · 适合 大众
CC BY 4.0 · 已核验 · Verified 2026-08-23 · 2 条独立证据
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陈孝平 汪建平 主编,《外科学》第9版,人民卫生出版社,2018
Chen Xiaoping and Wang Jianping eds., Surgery, 9th ed., PMPH, 2018
独立核验依据 · Independent verification: 核验依据 2 ISBN 9787117266390（豆瓣书目条目: 外科学）
#手术部位感染 #备皮 #预防性抗生素
围手术期轻度低体温为什么会显著增加手术部位感染风险？术中把核心体温维持在正常范围通过哪些机制起保护作用？
Why does mild perioperative hypothermia markedly increase surgical site infection risk, and through which mechanisms does keeping core temperature normal during surgery protect patients?
核心体温仅下降1–2℃即触发外周血管收缩，组织氧分压随之降低，而中性粒细胞依靠需氧的呼吸爆发产生活性氧杀菌，缺氧使其效能锐减；低体温还损害血小板功能与凝血，增加出血和血肿风险。Kurz等的随机试验显示，轻度低体温使结直肠手术感染率由6%升至19%，并延长住院。指南因此要求术中主动加温，核心体温不低于36℃。
A core-temperature drop of just 1-2°C triggers peripheral vasoconstriction and lowers tissue oxygen tension; neutrophils depend on an oxygen-requiring respiratory burst to kill bacteria, so their efficiency plummets. Hypothermia also impairs platelet function and coagulation, increasing bleeding and haematoma risk. In Kurz's randomized trial mild hypothermia raised colorectal surgical-site infection from 6% to 19% and prolonged hospital stay, so guidelines mandate active warming to keep core temperature at or above 36°C.
难度 进阶 · 适合 初中(12-15)
CC BY 4.0 · 来源待核验 · Source pending review
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出处备注：著录含书名，但缺版次 / 出版社 / 年份中的一部分，需编辑补全后才能做独立比对。
Kurz A等围术期正常体温随机对照试验，《新英格兰医学杂志》(N Engl J Med) 1996年334卷
Kurz A, Sessler DI, Lenhardt R. Perioperative normothermia to reduce surgical-wound infection. N Engl J Med. 1996;334(19):1209-1215.
#围手术期 #低体温 #手术部位感染
接受腹部大手术的患者为什么要评估静脉血栓栓塞风险并常规采取预防措施，例如低分子肝素或间歇充气加压？
Why should patients undergoing major abdominal surgery receive venous thromboembolism risk assessment and routine prophylaxis such as low-molecular-weight heparin or intermittent pneumatic compression?
手术从三方面促发血栓：组织因子释放激活凝血系统、术后卧床导致静脉血流淤滞、操作直接损伤血管内皮，正合Virchow三要素。术后深静脉血栓常无症状，肺栓塞则是围手术期可预防死亡的首要原因之一。按Caprini评分分层后，高危且无活动性出血者应使用低分子肝素并与间歇充气加压联用；出血风险高时可暂以机械加压替代。
Surgery promotes clotting through three routes: tissue-factor release activating coagulation, bed rest causing venous stasis, and direct endothelial injury from instrumentation—precisely Virchow's triad. Postoperative deep vein thrombosis is often silent, and pulmonary embolism remains a leading cause of preventable perioperative death. After Caprini score stratification, high-risk patients without active bleeding should receive low-molecular-weight heparin combined with intermittent pneumatic compression; when bleeding risk dominates, compression devices substitute temporarily.
难度 进阶 · 适合 大众
CC BY 4.0 · 来源待核验 · Source pending review
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出处备注：此条未指向带版次的可引用著作（通识性内容、机构文件或未展开的英文书名），本库不提供独立书目出处；如需精确引用，需由编辑补全具体篇目与版次。
Geerts WH 等．静脉血栓栓塞预防：ACCP循证临床实践指南（第8版）．Chest，2008；133(6 Suppl)：381S-453S
Geerts WH, Bergqvist D, Pineo GF, et al. Prevention of Venous Thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest. 2008;133(6 Suppl):381S-453S
#静脉血栓栓塞 #Caprini评分 #围手术期预防