临床药师干预门诊外科围手术期预防用抗菌药物的对照研究

Control Study on Clinical Pharmacists' Interfering with Preventive Use of Perioperative Antibacterials in Outpatient Surgery

目的探讨临床药师的干预对门诊外科围手术期预防使用抗菌药物的影响。方法采用回顾性分析方法,随机抽取本院门诊外科Ⅰ类、Ⅱ类切口手术患者,以2007年(干预前)的232例作为非干预组,2009年(干预后)的243例作为干预组,调查分析干预前后围手术期预防使用抗菌药物的情况。结果抗菌药物使用率非干预组为86.64%,干预组为58.02%(P<0.01);干预组较非干预组抗菌药物平均费用降低61.1元,降低了62.03%(P<0.01);药品不良反应发生率由干预前的13.36%降至干预后的2.88%(P<0.01);术前30min用药率由干预前的7.76%上升至干预后的54.73%;切口感染率两组没有明显区别;术后用药时间超过48h的由干预前的27.59%降至干预后的5.35%(P<0.01);品种选择不当率由干预前的22.84%降至干预后3.29%(P<0.01)。结论通过药师提供有效的药学服务和干预,可明显改善门诊外科围手术期预防使用抗菌药物的合理性。

Objective To discuss the influence of clinical pharmacists＇ intervention on preventive use of perioperative antibacterials in outpatient surgery. Methods A retrospective study was conducted, in which 475 patients with grade Ⅰ or Ⅱ incision in outpatient surgery received the preventive use of perioperative antibacterials. 232 patients in 2007 （before intervention） were as non-intervention group, 243 patients in 2009 （after intervention） were as intervention group. Results The rate of using antibacterials was 86. 64% in non-intervention group and 58. 02% in intervention group（ P〈0. 01） . The average costs for antibacterials in intervention group were reduced by 61. 1yuan （62. 03% ） compared with non-intervention group（ P〈0. 01） . The incidence of ADR was reduced from 13. 36% before intervention to 2. 88% after intervention（ P〈0. 01）. Prophylactic antibacterials application rate at preoperative 30 min rose from 7. 76% before intervention to 54. 73% after intervention. There was no obvious difference on the rate of wound infection in two groups. The proportion of postoperative antibacterials using time over 2 d was reduced from 27. 59% before intervention to 5. 35% after intervention（ P〈0. 01） . The rate of improper choosing drugs was reduced from 22. 84% before intervention to 3. 29% after intervention（ P〈0. 01） . Conclusion The effective pharmaceutical service and intervention provided by clinical pharmacists help to improve the rational using level of antibacterials in outpatient surgery. The work of clinical pharmacists is very beneficial.