围手术期预防应用抗菌药物调查分析

Survey of the Perioperative Prophylactic Use of Antimicrobial Agents in Guangzhou 12 Hospital

目的分析围手术且抗菌药物使用基本情况及存在问题。方法对我院围手术期预防用药情况进行调研。随机抽取2008年1月～2008年6月手术病历300份,对围手术期预防性应用抗菌药物的合理性进行分析。结果(1)围手术期预防性抗菌药物使用率为100%。(2)用药种类:按频次高低排序前三位是二代头孢、喹诺酮类、三代头孢;喹诺酮类占用药者的26.7%,一代头孢仅占6%;(3)每例平均用药天数:Ⅰ类切口为6.5d,Ⅱ类切口为8.2d,Ⅲ类切口为8.5d;(4)用药时机:无一例预防用药在手术开始前2h内用使用,47.8%手术病人首次用药距手术开始时间>2h,手术结束后才用药占52.2%;(5)13.3%病例无用药适应症;(6)在抗菌药物的用法、用量、药物更换以及联合用药的指征掌握、药物配伍等方面也存在着许多不合理现象。结论我院围手术期抗菌药物使用率过高,疗程过长,在药物选择、用药时机、联合用药方面不合理、不规范的情况普遍,急需改进,且在各方面努力下,应该有很大的改进空间。

Objective To investegate and analyze the petiopetative prophylactic use of antimicrobial agents in Guangzhou 12 hospital. Methods 500 medical records （from January to June, 2008）were drawn out randomly.The perioperative prophylactic use of antimicrobial agents was investigated and analyzed. Results Prophylatic antimicrobial agents were use in all the cases （100%）. The first 3 kinds of antimicrobial agents most in use were cephalosporins of 2nd generation （110/300, 36.7%）, fluoroquinolones （76/300, 25.3%）, 3nd generation （44/300, 14.7%）. The average durations of antibiotic use were 6.5 d for class I （clean） operations, 8.2 d for classⅡ （clean/contaminated） operations and 8.5 d for class Ⅲ （contaminated）operations. No patients received antibiotics within 2 h porior operation, 47.8% patients received antibiotics before 2 h porior operation and 52.2% of patients did not received antibiotics until the operation was completed. Indications for prophylactic antibiotic use did not exist in （13.3%） of cases. Combinatetions of antimicrobial agents were use in 40% of patients,of them, 25% without resonable indications. Conclusion Inappropriate use of perioperative prophylactic antimicrobial agents is common and must be subjected to standardization.