某院骨科关节置换术患者不同抗菌药物预防性给药方案的成本-效果分析

Cost-EffectivenessAnalysis of DifferentAntibacterial Drug Prophylaxis Regimens for Patients Undergoing JointReplacement in theOrthopedics Department of aHospital

目的:分析医院骨科髋关节与膝关节置换术患者不同抗菌药物预防性给药方案的成本-效果情况,为该类患者抗菌药物的合理使用提供参考。方法:选取2019年1月—2021年4月南通大学附属南通第三医院收治的114例髋关节与膝关节置换术患者作为研究对象,按抗菌药物预防性给药方案的不同将其分为甲组、乙组和丙组,每组38例;甲组患者术前0.5~1 h时给予头孢唑林(2 g,q12h),总疗程≤48 h;乙组患者的用药方案与甲组相同,但总疗程>48 h;丙组患者术前0.5~1 h时给予头孢曲松(2 g,q12h),总疗程>48 h;比较3组患者的术后感染发生率、最高体温、术后体温复常时间、住院时间、抗菌药物费用等指标。结果:3组患者术后均未发生感染;3组患者术后在最高体温和体温复常时间方面的差异无统计学意义(P>0.05);在住院时间和抗菌药物方面,均存在甲组>乙组>丙组的情况,且两两比较均有显著性差异(P<0.05);成本-效果比较结果显示,甲组患者的抗菌药物预防性给药方案具有最大的成本-效果优势(P<0.05)。结论:对于髋关节与膝关节置换术患者,按照指导原则术前0.5~1 h给予第1代头孢菌素头孢唑林且总疗程≤48 h,具有最大的成本-效果优势,不仅可以有效预防术后感染的发生,还可以最大程度降低患者的经济负担。

Objective:To analyze the cost-effectiveness of different antibacterial drugs prophylaxis regimens for patients undergoing hip and knee arthroplasty in the Orthopedics Department of the hospital,so as to provide reference for the rational use of antibacterial drugs in such patients.Methods:A total of 114 patients undergoing hip and knee arthroplasty admitted to Nantong Third Hospital Affiliated to Nantong University from January 2019 to April 2021 were chosen as the subjects,and they were divided into group A,group B and group C according to the different antibacterial drug prophylaxis regimens,with 38 cases in each group.Patients in group A were given cefazolin(2 g,q12h)0.5-1 h before operation,and the total course of treatment was less than or equal to 48 h;the medication regimen of patients in group B was the same as that in group A,but the total course of treatment was more than 48 h.Patients in group C were given ceftriaxone(2 g,q12h)0.5-1 hour before operation,and the total course of treatment was more than 48 h.The indicators such as the incidence of postoperative infection,maximum body temperature,time of recovery to normal body temperature after operation,hospitalization time and cost of antibacterial drugs of patients in the three groups were compared.Results:No postoperative infection occurred in the 3 groups of patients;there were no significant differences in the maximum body temperature and time of recovery to normal body temperature after operation among the 3 groups of patients(P>0.05);the hospitalization time and use of antibacterial drugs in group A were more than those in group B and more than those in group C,and there was significant difference between any two groups(P<0.05);the costeffectiveness comparison results showed that the antibacterial drug prophylaxis regimens for patients in group A had the maximum cost-effectiveness advantage(P<0.05).Conclusion:For patients undergoing hip and knee arthroplasty,the administration of the first-generation cephalosporin cefazolin 0.5-1 h before operation according to the guiding principle and the total course of treatment equal to or less than 48 h have the maximum cost-effectiveness advantage,which can effectively prevent the occurrence of postoperative infection and minimize the economic burden of patients.