踝关节骨折临床路径中抗菌药物应用的优化

Optimization of the Application of Antibiotics in Clinical Pathway of Ankle Joint Fracture

目的:筛选踝关节骨折临床路径中预防性应用抗菌药物的合理化用药方案。方法:回顾性分析我院2008-2010年204例踝关节骨折围手术期预防性应用抗菌药物的情况,筛选出磺苄西林钠、头孢呋辛钠、头孢孟多酯钠和头孢美唑钠4种抗菌药物进行成本-效果分析。结果:204例患者预防性应用抗菌药物使用率100%,术前0.5～2h用药44例(21.57%),平均用药时间(6.03±2.51)d。磺苄西林钠、头孢呋辛钠、头孢孟多酯钠和头孢美唑钠的成本分别为1987.20、892.56、3644.28、1241.28元,有效率分别为71.43%、87.50%、88.46%、97.50%,成本-效果比分别为2782.02、1020.07、4119.69、1273.11,头孢孟多酯钠和头孢美唑钠相对于头孢呋辛钠的增量成本-效果比分别是286637.50和3487.20。结论:实施踝关节骨折临床路径需要优化抗菌药物的预防性应用,头孢呋辛钠可作为较佳用药方案。

OBJECTIVE：To select the reasonable drug regimen of the prophylactic application of antibiotics in the clinical pathway of ankle joint fracture.METHODS：We investigated retrospectively perioperative prophylactic application of antibiotics in 204 cases of ankle joint fracture from 2008 to 2010 in our hospital.The cost-effectiveness analyses were performed among sulbenicillin sodium,cefuroxime sodium,cefamandole nafate and cefmetazole sodium.RESULTS：204 patients all received prophylactic antibiotics preoperatively.44 patients were given antibiotics 0.5 to 2 hours before surgery（21.57%）;mean medication time was（6.03± 2.51）d.The costs of sulbenicillin sodium,cefuroxime sodium,cefamandole nafate and cefmetazole sodium were 1 987.20 yuan,892.56 yuan,3 644.28 yuan and 1 241.28 yuan,respectively;the effective rates were 71.43%,87.50%,88.46% and 97.50%,respectively;the cost-effectiveness ratios were 2 782.02,1 020.07,4 119.69 and 1 273.11,respectively.The incremental cost-effectiveness ratios of cefamandole nafate and cefmetazole sodium were 286 637.50 and 3 487.20 respectively as against cefuroxime sodium.CONCLUSIONS：The prophylactic application of antibiotics in clinical pathway of ankle joint fracture needs optimization,and cefuroxime sodium is the best proposal to prevent perioperative infection.