Ⅰ类切口手术的目标性监测分析

Targeted monitoring of type Ⅰ incision operation

目的研究目标性监测方法在Ⅰ类切口手术围手术期合理使用抗菌药物与预防控制手术部位相关感染的作用。方法利用该院自行开发的监测软件和其他跟踪服务系统,选择乳腺、甲状腺、腹股沟疝3种手术,从2010年起对手术部位感染率及围手术期预防使用抗菌药物的合理性等指标进行目标性监测。结果至2011年第四季度,上述3种Ⅰ类切口手术部位的感染率无变化,而其使用抗菌药物的各项指标及平均西药费用等指标均明显优于以往;其中乳房乳腺手术、甲状腺手术抗菌药物使用率由2009年的100.0%、100.0%分别下降至53.46%和74.77%;乳房乳腺手术、甲状腺手术、腹股沟疝手术的抗菌药物平均使用天数由(9.40±4.22)、(8.28±1.99)、(8.94±2.76)d分别下降至2011年的(1.46±2.12)、(1.67±1.85)、(2.79±2.51)d;随着抗菌药物使用率、使用疗程及联合用药指标的改善,平均住院费用、平均西药费用、平均住院日也相应得到改善。结论目标性监测方法在Ⅰ类切口手术围手术期合理使用抗菌药物与预防控制手术部位相关感染方面起到有效作用,值得运用与推广。

OBJECTIVE To explore the role of targeted monitoring in reasonable use of antibiotics and prevention and control of surgical site infections during the perioperative period of type Ⅰ incision surgery.METHODS By means of the self-developed monitoring software and other tracking service system,three kinds of surgeries including mammary gland,thyroid and inguinal hernia surgery were adopted,the targeted monitoring was performed for the indexes including the incidence of surgical site infections and the rationality of prophylactic antibiotics during perioperative period since 2010.RESULTS Until the fourth quarter of 2011,there was no chance in the incidence of the surgical site infections due to the three kinds of type Ⅰ incision surgery,but the average duration of antibiotics used for mammary gland surgery,thyroid surgery,and inguinal hernia surgery respectively decreased from（9.40±4.22）d,（8.28±1.99）d,and（8.94±2.76）d to（1.46±2.12）d,（1.67±1.85）d,and（2.79±2.51）d;along with the utilization rate of antibiotics,the application course and the combined use indicators being improved,the average hospitalization cost,average western drug cost,and average hospital stay were improved accordingly.CONCLUSION The targeted monitoring plays an effective role in the reasonable use of antibiotics and prevention and control of surgical site infections during the perioperative period of type Ⅰ incision surgery,which is worthy of promotion.