3种Ⅰ类切口手术围术期预防性应用抗菌药物干预效果分析

Analysis on Intervetion Effects of Perioperative Prophylactic Application of Antibiotics in 3 Kinds of Type Ⅰ Incision Operation

目的:评价干预前、后我院甲状腺、乳腺、疝气修补3种Ⅰ类切口手术围术期预防性应用抗菌药物的合理性与实施干预措施的效果。方法:选取我院2011年1-3月(干预前)和2012年1-3月(干预后)3种Ⅰ类切口手术出院患者病历共360份,进行围术期预防性应用抗菌药物合理性对比分析。结果:干预后抗菌药物预防性应用率显著下降,由干预前的98.19%下降为干预后的18.56%(P<0.01);无适应证用药患者的比例从干预前的83.73%下降到干预后的5.15%(P<0.01);用药疗程>24h的患者比例从干预前的69.88%下降到干预后的8.25%;选药起点过高或不当的患者比例从干预前的79.52%下降到干预后的6.19%,不合理用药现象得到了明显改善。结论:我院采取的干预措施有效,能促进3种Ⅰ类切口手术围术期抗菌药物的合理应用。但还存在疝气修补术补片植入病例抗菌药物预防使用率过高和给药时机不合理的情况,需要结合有关规定进行持续改进。

OBJECTIVE： To evaluate the rationality of perioperative prophylactic application of antibiotics before and after in- tervention and the effect of intervention in the thyroid, breast, hernia repair type I incision operation. METHODS： 360 cases with type I incision were selected during Jan. -- Mar. , 2011 （before intervention） and Jan. -- Mar. , 2012 （after intervention）, and ratio- nality of perioperative prophylactic application of antibiotics were analyzed comparatively. RESULTS： After the intervention, the prophylactic use of antibiotics was significantly decreased from 98.19% before intervention to 18.56% after intervention （P〈 0.01） ; the proportion of medication without indication was decreased from 83.73% to 5.15% （P〈0.01） ; the proportion of treat- ment course ~24 h was decreased from 69.88% to 8.25% （P〈0.01） ; the proportion of drug selection starting point too high or improper selection of drug was decreased from 79.52% to 6.19% （P〈0.01）, and irrational drug use had been improved obviously. CONCLUSION： The intervention is effective and can promote perioperative rational use of antibiotics in 3 kinds of type I incision operations. But there are still high rate of antibiotics use and unreasonable medication time in the hernia patch implantation cases. It should be improved according to the regulation.