普通外科Ⅰ类切口手术围术期预防性使用抗菌药物MTP干预

Monitoring-training-planning intervention in perioperative prophylactic use of antimicrobial agents for class-Ⅰ incision surgery

目的探讨监测-培训-计划(monitoring-training-planning,MTP)合理用药干预模式对Ⅰ类切口手术围术期预防性使用抗菌药物的干预效果。方法按照"2011全国抗菌药物临床应用专项整治活动方案"及世界卫生组织/合理用药国际网络选择性用药指标调研方法设定调研指标,选取2011年第1季度普通外科Ⅰ类切口手术患者病历作为调研基线,采用MTP模式进行干预,每季度统计分析干预后的调研指标,然后再干预再调研,如此进行3个MTP循环。结果经过3轮MTP干预后,普通外科Ⅰ类切口手术围术期预防性使用抗菌药物率、平均用药天数及联合用药率分别由干预前的100.00%、(1.65±0.80)d、15.00%下降至干预后的26.32%、(0.26±0.46)d、0.00%,上述指标干预前后比较,差异均有统计学意义(均P<0.05);术前0.5～2 h用药百分率与品种选择合理率经干预后均达到100.00%。结论 MTP合理用药干预模式有效提高了普通外科Ⅰ类切口手术围术期预防性使用抗菌药物的合理用药水平。

Objective To study the effect of monitoring-training-planning（MTP） intervention approach on periop- erative prophylactic antimicrobial use in class- I incision surgery. Methods In accordance with the Clinical Anti- microbial Application Supervision Scheme in China in 2011 and rational drug selection indicators of World Health Organization , the case histories of patients receiving class- I incision operation in department of general surgery in the first quarter of 2011 were selected as the baseline, and MTP intervention was then carried out, during the next three quarters, investigated indicators were analyzed. In this way, three cycles of MTP intervention investigation were implemented, Results After three cycles of interventions, rate of perioperative prophylactic antimicrobial use , average drug exposure days , and rate of combination of antimicrobial agents decreased from 100. 00%, （1.65 ± 0. 80） days and 15.00% to 26. 32%, （0. 26 ± 0. 46） days and 0. 00% （All P〈0. 05） respectively; preoperative anti- microbial use rate （0. 5 - 2 h before operation） and rational drug selection rate both reached 100. 00%. Conclusion MTP intervention mode is feasible and effective in promoting the rational use of antimicrobial agents for periopera- tive prophylaxis in class- I incision surgery.