胸外科肺部Ⅱ类切口围术期预防应用抗菌药物临床药径的构建与实践

Establishment and practice of clinical pathway for perioperative prophylaxis of antimicrobial agents in patients with pulmonary type Ⅱ incision in thoracic surgery

目的探究临床药师实施临床药径管理对胸外科肺部Ⅱ类切口围术期预防应用抗菌药物的影响。方法临床药师参与制定胸外科肺部Ⅱ类切口围术期预防应用抗菌药物的临床药径,构建评价体系,并结合临床实践逐步完善。选取临床药径实施前(2020年6至11月)270例患者作为干预前组,临床药径实施后(2021年6至11月)311例患者作为干预后组,对干预前、干预后组患者围术期预防应用抗菌药物的品种选择、给药时机、术中追加、用药时长、用法用量、人均抗菌药物金额和围术期抗菌药物使用强度等指标进行分析。结果干预后头孢呋辛的使用比例由55.19%升至74.28%,给药时机不适宜率由29.26%降至13.83%,用法用量不适宜率由21.11%降至2.57%,用药时长由96(72,120)h缩短至48(24,72)h,人均抗菌药物金额由(461.16±235.85)元降至(237.84±121.35)元,抗菌药物使用强度由44.51 DDDs/百人天降至25.93 DDDs/百人天,且上述指标在干预前后组之间的差异均具有统计学意义(P<0.05)。结论临床药径管理使围术期抗菌药物临床应用更加规范,在降低细菌耐药风险的同时减少了患者的药品费用,也使抗菌药物使用强度趋于合理化。

AIM To evaluate the effect of continuous intervention by clinical pharmacists on the rational use of antimicrobial agents in the perioperative period of thoracic surgery with classⅡpulmonary incision.METHODS Clinical pharmacists were involved in developing a clinical pathway for perioperative prophylaxis of antimicrobial agents in patients with pulmonary typeⅡincision in thoracic surgery,constructing an evaluation system,and gradually improving it in clinical practice.Totally 270 patients before the implementation of the clinical pathway(from June to November,2020)were selected as the pre intervention group,and 311 patients after the implementation of the clinical pathway(from June to November,2021)were selected as the post intervention group.The selection of varieties,timing of administration,intraoperative supplementation,duration of medication,usage and dosage,amount of antimicrobial agents per capita,and intensity of antimicrobial agents use during the perioperative period were analyzed.RESULTS After the intervention,the use ratio of cefuroxime increased from 55.19%to 74.28%,the inappropriate timing of administration decreased from 29.26%to 13.83%,and the inappropriate usage and dosage rate decreased from 21.11%to 2.57%,respectively.The duration of continuous medication was shortened from 96(72,120)h to 48(24,72)h,the amount of antimicrobial agents per capita decreased from(461.16±235.85)yuan to(237.84±121.35)yuan,and the use intensity of antimicrobial agents dropped from 44.51DDDs/100 person-days to 25.93DDDs/100 person-days.CONCLUSION Clinical pharmacists intervene in the whole process of perioperative antibacterial prophylaxis,which makes the clinical application of antibacterial drugs more standardized,reduces the risk of bacterial resistance,reduces the drug cost of patients,and rationalizes the use of antibacterial drugs.