心胸外科清洁手术预防性使用抗菌药物的调查

Study on prophylactic use of antibacterial agents during clean surgery in department of cardiothoracic surgery

目的了解某三级甲等医院心胸外科清洁手术预防性使用抗菌药物情况,判断其合理性。方法对医院2010年1-12月心胸外科清洁手术共106例进行前瞻性的调查,设计统一的表格,逐项填写并录入电脑后进行统计。结果 106例手术患者中,共8例患者发生感染,感染率为7.55%;预防性抗菌药物使用率为100.00%,抗菌药物应用前5位的为:头孢米诺、头孢哌酮/舒巴坦、头孢哌酮/他唑巴坦、头孢克罗、头孢唑林;术前预防性抗菌药物使用给药时间均>2h,术中用药占60.8%,术后预防性抗菌药物使用疗程1～39d,有97.96%病例术后停药时间>72h。结论该院心胸外科清洁手术术前预防性抗菌药物使用给药时间不合理;疗程明显过长;抗菌药物选择档次偏高;应进一步加强抗菌药物的使用管理,以期达到规范化使用。

OBJECTIVE To investigate the application of prophylactic antibacterial agents during clean surgery in cardiothoracic surgery department of a third-grade class-A hospital and to analyze its rationality.METHODS A prospective survey of the clinical data of 106 patients who underwent clean surgery in department of cardiothoracic surgery from Jan to Dec in 2010 was conducted,Using a unified form,we input the data and performed the statistical analysis.RESULTS Of 106 patients who underwent the clean surgery,nosocomial infections occurred in 8 cases with the infection rate of 7.55%;the utilization rate of the prophylactic antibacterial agents was 100.00%,the top 5 antibacterial agents were cefminox,cefoperazone/sulbactam,cefoperazone/tazobactam,cefaclor,and cefazolin;the duration of preoperative use of prophylactic antibacterial agents was more than 2 hours,the use of antibiotics during the operation accounted for 60.8%;the course of the postoperative prophylactic use of antibiotics was 1-39 d,the majority of the cases（97.96%） stopped using antibiotics longer than 72 hours after operation.CONCLUSION The delivery time of prophylactic antibacterial agents of preoperative clean surgery in cardiothoracic surgery department is irrational;the course is excessively long;the selection grade of the antibiotics is electively high;it is necessary to further strengthen the administration of use of antibiotics so as to achieve the basically standardized use of antibiotics.