174例手术患者抗菌药物应用的调查分析

Antibiotics for 174 Patients with Surgical Operations:A Utilization Survey Analysis

目的 了解手术科室抗菌药物的应用 ,进一步规范手术科室正确使用抗菌药物。方法 随机抽查进行手术的外科病例 174份 ,调查其抗菌药物应用的情况。结果 所有被调查的病例均使用了抗菌药物 ,其中预防用药占 84 .4 8% ,术前 1h内给药者占预防用药的 36 .73% ,治疗用药占 15 .5 2 % ;抗菌药物的疗程为 1～ 2 7d,多数病例为 4～ 12 d,术后预防用药最长 2 2 d, 类切口多为 4～ 7d, 类切口 4～ 12 d;多数病例为单用或二联 ;共用品种多为 1～ 2种 ,最多达 8种 ;用药频数从高到低前 7位依次为头孢呋辛、左氧氟沙星、阿米卡星、青霉素 G、甲硝唑、阿莫西林 ,头孢唑林 ;预防用药排位 :头孢呋辛、左氧氟沙星、青霉素 G、阿米卡星、美洛西林、甲硝唑 ;部分病例应用三代头孢预防手术部位的感染。结论 手术科室普遍采用抗菌药物预防手术部位的感染 ,但严格按围手术期预防用药原则应用者少、手术后预防用药的时间长、选用的品种起点高、存在不必要的联用等 。

OBJECTIVE To investigate the usage of antibiotics in surgical department for improving the proper clinical utilization. METHODS A total of 174 patients with surgical operations who discharged from our hospital on Jan to Mar 2003 were surveyed retrospectively. RESULTS All patients were given antibiotics.The rate of antibiotics was 84.48%, 54 patients were received antibiotics in one hour before the operations. The rate of treating usage was 15.52%. The duration of antibiotics usage was 1-27 days, most of that were 4-12 days. The duration of postoperation prophylaxis was: for Ⅰ type incision 4-7 days, for Ⅱ type incision 4-12 days, the longest one was 22 days. Most patients were received one or two kinds of antibiotics during hospitalization, one patient received eight kinds. The sequence of the frequency of antibiotics usage was (from high to low): cefuroxime, levofloxacin,amikacin, penicillin G, metronidazole, amoxicillin, cefazolin. The sequence of prophylactic frequency was: cefuroxime, levofloxacin, penicillin G, amikacin, mezlocillin, metronidazole. Some patients were used cephalosporins to prevent SSI. CONCLUSIONS It is common that antibiotics are used to prevent surgical system infection (SSI) in surgical department, but most don′t follow the principle of antibiotics prophylaxis strictly during perioperative period. The major problems are excessive prophylaxis in surgical system, long duration of antibiotics prophylaxis after operation, excessive selection to expensive antibiotics and unnecessary combination of antibiotics. It is important to strengthen the management of antibiotics.