妇科围手术期抗菌药物合理应用的干预对照研究

Rational Antibiotics Use During Perioperative Period of Hysteromyomectomy:An Intervention Study

目的通过妇科围手术期抗菌药物合理应用的干预对照研究,探索适合我国国情的手术预防使用抗菌药物干预模式,推动我国合理用药工作的开展。方法选取2000年经腹子宫肌瘤或子宫肌瘤+附件手术病例,进行回顾性调查分析,找出临床围手术期预防性应用抗菌药物存在的主要问题,参照国内外有关文献,制订妇科围手术期抗菌药物用药指南;依据该指南,在2001年进行前瞻性干预研究,2002年随访干预后情况。结果使用抗菌药物的合理率由干预前的0%上升到干预中的89.73%和干预后的30.56%(P<0.01);基本合理率由干预前的0%增加为干预中的10.27%和干预后的38.88%(P<0.01);干预前妇科围手术期预防性应用抗菌药物存在的主要问题,如抗菌药物品种选择不当、给药时机不当和用药疗程过长等干预后均有显著改善。结论本研究所采用的合理用药干预措施具有可行性和有效性,对促进安全、有效、经济、合理地使用抗菌药物起到了积极的促进作用,为医院降低单病种费用提供了一种有效且可行的模式。

OBJECTIVE To explore a set of scientific methods which are suitable for China′s situation and (promote) the development of rational drug use in China, we undertake the intervention study for rational antibiotics use on perioperative period of hysteromyomectomy. METHODS Selected the surgical inpatient cases of hysteromyomectomy plus appendix in Jun 2000 and found out the problems of irrational drug use. Then developmented a treatment guideline for antibiotic prophylaxis. The guideline was formulated following the international guideline and the (national) experience. Carried out intervention and comparison research on the same period in 2001. For the (guideline) to have maximum effect, we implemented in a systematic way using a variety of educational, managerial and regulatory techniques. Followed up the effect of the intervention in Jun 2002. RESULTS The rational rate of antibiotics use with guideline increased from 0 (before intervention)to 89.73% (during intervention)and to (30.56%) (after intervention) (P<0.01).Some major problems such as irrational choice of antibiotics, incorrect time of drug administration and over-long course of drug treatment were improved significantly after intervention. CONCLUSIONS The intervention methods used in this study are proved practicable and effective for rational drug use. They will contribute to the decrease medical expense and promote the safe, effective and economic antibiotic use in China.