基层医院Ⅰ类手术围手术期预防用抗菌药物干预对照研究

Intervention control study on prophylactic antibiotics use during perioperative period of classⅠoperation in primary hospitals

目的探讨基层医院Ⅰ类手术围手术期预防用抗菌药物的合理性。方法将医院骨科2009年第一、四季度同期出院的Ⅰ类切口手术患者179例进行干预对照研究,其中第一季度为干预前,第四季度为干预后。结果干预前后比较,抗菌药物应用率由100.00%下降至80.00%(P<0.05),其中用药无适应证比例由干预前55.96%下降为干预后34.29%;干预前预防用抗菌药物共涉及9大类25种,居首位是头孢菌素类,占67.37%,前3位品种分别是阿洛西林、头孢西丁、头孢替安;干预后共涉及6大类13种,居首位为头孢菌素类,占73.21%,居前3位则为头孢唑林、左氧氟沙星、头孢拉定。结论干预组实施综合干预措施可行、有效,能显著降低Ⅰ类切口手术围手术期预防用抗菌药物应用率,提高抗菌药物合理使用,并对促进临床安全、有效、经济地应用抗菌药物具有良好效果。

OBJECTIVE To probe into the rational use of antibiotics during perioperative period of classⅠoperation in primary hospitals.METHODS An intervention control-study was conducted for 179 patients who underwent class Ⅰ incisions surgeries in orthopedics and discharged in the same period during the first and fourth quarter of 2009;the first quarter was before the intervention,and the fourth quarter was after the interventions.RESULTS The rate of the use of antibiotics decreased from 100.00% to 80.00%（P〈0.05） after interventions;the proportion of the medication without indications decreased from 55.96% to 34.29% after interventions;there were totally 9 categories 25 types of prophylactic antibiotics involved before the interventions,among which cephalosporins（67.37%） ranked the top,and the top three categories were azlocillin sodium injection,cefoxitin sodium and cefotiam;there were 6 categories 13 types of antibiotics involved after the interventions,among which cephalosporins（73.21%） ranked the top,and the top three antibiotics which included levofloxacin,cefazolin,and cephradine.CONCLUSION The integrated interventions in the intervention group were feasible and effective,and the utilization rate of antibiotics was significantly reduced.The intervention can improve the rational use of antibiotics and promote the application of antibiotics in a safe,effective,and economical manner.