急性阑尾炎围手术期抗菌药物的临床应用

Clinical application of antibacterials during perioperative period of acute appendicitis

目的了解医院阑尾炎围手术期使用抗菌药物情况,探讨其联合使用的合理性。方法随机抽取2011年1月阑尾炎患者病历32份进行统计分析。结果手术病例26例,抗菌药物使用率100.0%,单联、二联、三联使用率分别为3.8%、61.5%、34.6%,病原学检查送检率为19.2%,阳性率80.0%,检出细菌有铜绿假单胞菌、大肠埃希菌、产碱菌属、摩氏摩根菌;平均住院日为6d,抗菌药物平均使用为6d,所占药费比例平均为63.4%,药物不良反应发生率为26.9%。结论抗菌药物使用率高于医院等级晋升要求,联合用药存在抗菌谱重叠、未覆盖致病菌等不合理使用现象。

OBJECTIVE To understand the use of antibacterials in perioperative period after appendectomy and investigate rationality of combination. METHODS Statistical analysis was carried out for medical records of 32 patients with appendicitis randomly selected in Jan 2011. RESULTS There were 26 cases of surgery where usage rate of antimierobial was 100.0%. Rates of single use, two-drug combination and three-drug combination were 3.8%, 61.5% and 34. 6% respectively. Etiological test rate was 19.2% and positive rate was 80.0%. Pseudomonas aeruginosa, Escherichia coIi, producing alkali bacteria and Morgan bacteria were detected. The average h0spitalization time was six days. The average duration of antimicrobial use was 6 days, accounting for 63.4% of medical cost at average. The incidence of adverse drug reaction was 26. 9%. CONCLUSION The use rate of antibiotics is higher than the upgrading requirement of hospital, and unreasonable use of antimicrobial was observed in the combination therapy including overlapped antibacterial spectrum and/or uncovered pathogenic bacteria.