基于属性层次模型评价普外科围术期预防性使用抗菌药物的合理性研究

Study on the rationality of perioperative prophylactic use of antibiotics in general surgery based on the attribute hierarchical model

目的建立普外科围术期预防性使用抗菌药物合理性的评价标准,为普外科围术期合理预防性使用抗菌药物提供依据。方法以《抗菌药物临床应用指导原则(2015版)》和相关药品说明书为标准,相关专家共识及指南为辅助,制定普外科围术期预防性使用抗菌药物合理性的评价标准。基于属性层次模型(AHM)对2021年12月至2022年5月普外科207例手术患者的病历进行分析评价,根据AMH确定合理性评价标准中各指标的属性权重,依据相应属性权重对病历进行赋分。结果归档病历中男性87例、女性120例。Ⅰ类切口有81例,占比39.13%;Ⅱ类切口126例,占比60.87%。普外科围术期预防性使用抗菌药物不合理的问题主要为给药时机不适宜(多数在术后预防)、给药疗程较长(疗程在3~8 d)及选药不适宜(如围术期选择头孢他啶预防)等。207份病历中分值≥90的病历有84份(40.58%),80≤分值<90的病历有31份(17.98%),70≤分值<80的病历有68份(32.85%),分值<70的病历有24份(11.59%)。结论普外科围术期预防性使用抗菌药物存在不合理问题,需继续监控考核。AHM能够客观、量化地呈现临床用药合理性评价结果,该方法的应用可以为医院抗菌药物管理制度的制定提供参考,促进临床合理用药。

AIM To establish an evaluation standard and provide evidence for rational prophylactic use of antibiotics in perioperative period of general surgery.METHODS Based on"the Guiding Principles of Clinical Application of Antibiotics(2015 edition)"and related drug instructions,and assisted by relevant expert consensus and guidelines,the evaluation criteria for the rational prophylactic use of antibiotics in perioperative period of general surgery were established.Based on the attribute hierarchical model(AHM),a total of 207 medical records of patients from December 2021 to May 2022 in general surgery were analyzed and evaluated.The attribute weights for each indicator in the rationality evaluation criteria were determined according to the AHM,and scores were assigned to the medical records based on the corresponding attribute weights.RESULTS In the archived cases,there were 87 males and 120 females.Type I incision accounted for 39.13%,with 81 cases,while TypeⅡincision accounted for 60.87%,with 126 cases.The main issues of irrational prophylactic use of antibiotics in the perioperative period of general surgery were inappropriate timing of drug administration(mostly prophylactic use after operation),prolonged duration of drug administration(3-8 d)and inappropriate drug selection(such as ceftazidime selected for prophylactic use during perioperative period).Among the 207 medical records,84 cases had scores more than 90,accounting for 40.58%.31 cases had scores between 80 and 90,accounting for 17.98%.68 cases had scores between 70 and 80,accounting for 32.85%.and 24 cases had scores less than 70,accounting for 11.59%.CONCLUSION The prophylactic use of antibiotics in perioperative period of general surgery is unreasonable and needs to be monitored and evaluated.AHM method can objectively and quantitatively present the results of the rational assessment of clinical drug use.Its application can provide reference for the establishment of the hospital's antibiotics management system and promote rational drug use in clinical practice.