Ⅰ类切口清洁手术围术期预防使用抗菌药物评价

Evaluation on prophylactic application of antimicrobials in perioperative period of type Ⅰincision operations

目的了解某三级医院的甲状腺手术、乳腺手术、腹股沟斜疝修补术、闭合性骨折4种Ⅰ类切口清洁手术预防性使用抗菌药物的情况,评价其合理性,为临床合理应用抗菌药物提供依据。方法随机抽取医院2010年6～12月4种清洁手术归档病例120份,制订抗菌药物合理应用评价标准,调查围术期抗菌药物的应用情况,选取适应证、药物选择、用药时机及疗程、溶媒选择、用法用量、联合用药等指标,进行抗菌药物预防使用的合理性评价。结果抗菌药物预防使用率为100%;所使用抗菌药物涉及6大类16个品种,使用较多的品种有五水头孢唑啉钠44例次(24.72%)、头孢西丁钠24例次(13.48%)、头孢曲松钠24例次(13.48%)、头孢呋辛钠22例次(12.36%);术前0.5～2.0 h首次使用抗菌药物有81例(67.5%),术前未用术后用药37例(30.8%);术后用药均超过48 h。结论该院4种Ⅰ类切口清洁手术预防性使用抗菌药物存在指征把握不严、抗菌药物品种高选、用药时机不当及疗程过长等问题,有待进一步规范化管理。

Objective To study the prophylactic application of antimicrobials in four kinds of clean operations, including thyroidectomy, adenomammectomy, inguinal hemia repair and closed fractures, and to evaluate its rationality. Methods The clinical data of 120 patients performed clean operation in this hospital during June 2010 to December 2010 were randomly selected for formulating evaluation criteria for prophylactic application of antimicrobials in perioperative period of type I incision operations. Results 100% of patients with type I incision received proph-ylactic antimicrobials involving 16 varieties. The antibiotics with highest daily defined dosage were sodium cefazolin pentahydrate （44 cases, 24. 72% ）, cefoxitin sodium （24cases, 13.48% ）, ceftriaxone sodium （24cases, 13.48% ） and cefuroxime sodium （22 cases, 12.36% ） ; antibiotics in 81 cases （67.5%） were given in 0.5 -2 hours before operation, and they were given in 37cases （30.8%） after operation, the duration for post operative medication was over 48 hours. Conclusion There were some problems in prophylactic use of antimicrobial agents in clean operations such as indications were not strict, the category of antimicrobial agents was not properly chosen, the occasion for medication was not appropriate and antimicrobial agents were excessively applied etc,it is important to tackle these problems, and intervention measures need to be taken.