3种清洁手术围手术期抗菌药物合理应用调查分析

Prophylactic Use of Antibiotics During Perioperative Period in Patients Undergoing Three Types of Aseptic Operations in Our Hospital

目的:了解我院3种清洁手术(分别为甲状腺手术、乳腺手术、疝气修补术)围手术期预防性应用抗菌药物情况,为临床合理用药提供参考。方法:回顾性调查我院2008年3月份78例3种清洁手术患者围手术期预防性应用抗菌药物情况。结果:78例患者中,抗菌药物预防性应用率达100%;术前未用者37例(占47.44%);术前应用≤2h者仅为1例(占1.28%),>2h者40例(占51.28%);术中均未追加使用抗菌药物;术后抗菌药物使用率100%,术后应用时间(t)≤24h者3例(占3.85%),24h<t≤48h者4例(占5.13%),术后使用抗菌药物超过3d为74例(占94.87%),其中累计应用抗菌药物时间最长者达13d。预防性应用抗菌药物涉及9类,使用种类前3位抗菌药物为头孢菌素类,林可霉素类,复合β-内酰胺酶抑制剂、氟喹诺酮类;涉及药品19种,使用频次列前3位者分别为头孢他啶、克林霉素,阿莫西林钠/舒巴坦钠、左氧氟沙星。平均住院药品费用2308.33元、抗菌药物总费用占总药品费用的35.37%。结论:该院3种清洁手术预防性应用抗菌药物存在不合理现象,应引起重视,加强监督管理。

Objective： To evaluate the prophylactic use of antibiotics during perioperative period in patients undergoing thyroid surgery, breast surgery or herniorrhaphy. Methods： The case records of 78 patients undergoing thyroid surgery, breast surgery or herniorrhaphy in March 2008 were reviewed retrospectively regarding the prophylactic use of antibiotics. Results： All of the 78 patients （100%） received antibiotics, of whom, 1 （1.28%） received antibiotics at ≤ 2 h and 40（51.28%） at 〉2 h before operation; 3（3.85%） received antibiotics ate〈24 h and 4 （5.13%） at 24 h〈t≤48 h after operation. The longest duration of taking antibiotics was 13 days. 9 categories of antibiotics were used in the 78 patients, dominating the first place were cephalosporins, lincomycins, followed by composite β-lactamase inhibitors and quinolones. A total of 19 kinds of drugs were involved, leading the first three places were ceftazidime, clindamycin, amoxicillin sodium/sulbactam sodium and levofloxacin. The patients＇ total drug cost was 2 308.33 RMB on average, with the cost of antibiotics accounting for 35.37%. Conclusion： Great attention should be paid to the serious problem of irrational use of prophylactic antibiotics in the perioperative period in this hospital.