MTP模式在妇产科手术抗菌药物合理使用的探讨

MTP Mode in Antibiotics Use of Gynecological and Obstetric Surgery

目的探讨MTP模式在妇产科手术抗菌药物合理使用的应用成效。方法监测、培训、计划（MTP）联合宣传教育、监督管理等多种策略对子宫肌瘤和剖宫产手术抗菌药物的使用进行3次循环干预，分析MTP前和每一轮MTP后的抗菌药物使用天数、抗菌药物费用、联用率及同期病区医院感染率等。结果MTP前与第3轮MTP后比较，子宫肌瘤手术抗菌药物使用天数、费用分别下降39．6％和42．1％；剖宫产术抗菌药物使用天数、费用和二联率分别下降41．1％、40．6％和52．9％，差异均有统计学意义（P〈0．01）；1年后的调查结果显示，除产科剖官产的抗菌药物费用与MTP前差异无统计学意义外，其他指标均与MTP前差异有统计学意义；同期病区医院感染发生未出现上升趋势。结论MTP是一项较好的促进合理用药的质量管理模式，与传统的管理方法相比，更具人性化、规范化及透明化，对医院的各层面也产生了积极影响；为达到较理想的效果，建议对一个干预目标经过4～5个MTP循环，针对各种情况做好处方目标者对MTP的遵从。

OBJECTIVE To study the application effectiveness of monitoring-training-planning（MTP） mode in the antibiotics use of gynecological and obstetric surgery. METHODS MTP together with propaganda and education, supervision and management and other strategies were employed to make three rounds circulatory intervention with the antibiotics use for by hysteromyoma and cesarean section operation. By analyzing the days of the antibiotics use, the cost of antibiotics, the rate of combined use and the nosocomial infection （NI） rate of same wards during the same period before and after MTP respectively. RESULTS The days of the antibiotics use, the cost of antibiotics and the rate of triple use have all decreased after each round MTP（P〈0.05）. The investigation made a year later has revealed the significant differences before and after MTP in all indexes except the cost of antibiotics of the cesarean section; there is no increase tendency in the NI rate during the same period. CONCLUSIONS MTP is a nice quality management mode in promoting rational use of antibiotics. Compared with the traditional ways of management, MTP has the advantages of humanization, standardization and openness and it can make a positive impact on all levels of the hospital. In order to achieve a better result, it is suggested that MTP be made on an intervening target for four or five rounds and the prescription target be made to follow MTP in different situations.