干预前后Ⅱ类切口手术围术期预防性应用抗菌药物分析

Perioperative Use of Prophylactic Antibiotics before and after Intervention in Patients Undergoing Type Ⅱ Incision Operation

目的:通过对天津市第一中心医院400份病历的调查分析,了解卫生部办公厅颁布《关于抗菌药物临床应用管理有关问题的通知》(简称《通知》)及我院采取相应干预措施前后抗菌药物临床应用差异,进一步加强与规范Ⅱ类切口手术预防性应用抗菌药物的合理性。方法:以随机抽样法抽取我院2007—2010年各年度3、6、9、12月份Ⅱ类手术切口出院患者病历,4年共400份,设置干预组及非干预组进行对照研究。非干预组为颁布《通知》前(2007—2008年)的出院病历200份;干预组为颁布《通知》后(2009—2010年)且我院采用相应干预措施后的出院病历200份。对2组患者的年龄、性别、住院天数、住院费用、抗菌药物费用、药物选择及联合用药等方面进行统计分析。结果:干预组与非干预组相比在术前用药合理性、术后用药合理性方面均有显著差异(P<0.01、P<0.05);干预组预防性联合用药的比例显著降低(P<0.05);患者体温变化方面,2组差异无统计学意义(P>0.05);平均住院天数方面,干预组明显低于非干预组(P<0.05);平均抗菌药物费用方面,2组差异无统计学意义(P>0.05)。结论:干预后Ⅱ类切口手术不合理预防性应用抗菌药物的情况明显减少,医务工作者对抗菌药物使用的重视程度明显加强,干预对进一步规范临床抗菌药物的合理使用及细菌耐药性的减少具有重要意义。

OBJECTIVE：To investigate the antibiotic use before and after intervention in 400 cases from Tianjin Municipal First Central Hospital and familiarize the ＂Notice on Issues Related to the Management of Clinical Use of Antibiotics＂ issued by the general office of ministry of health（＂Notice＂ in short） and find out the difference of drug use before and after the issuing of the notice and strengthen and standardize the rationality in the use of prophylactic antibiotics for patients undergoing type II incision operation.METHODS：The medical records of a total of 400 patients undergoing type II incision operation who had been discharged from our hospital during Mar.,June,Sept.and Dec.from 2007 to 2010 were randomly selected for control study by dividing them into intervention group（200 cases collected after intervention,i.e.from 2009 to 2010） and non-intervention group（200 cases before intervention,i.e.from 2007 to 2008）.A statistical analysis was performed on patients＇ age and sex,days of hospital stay,cost of hospitalization,cost of antibiotics,choice of drugs and drug combination etc.RESULTS：Significant differences were noted between the intervention group and the non-intervention group with regard to the rationality in preoperative and postoperative antibiotic use（P0.01,P0.05）.The intervention group had significant lower rate of combination use of prophylactic antibiotics（P0.05）;there were no differences between the two groups in the change of body temperature（P0.05）;the intervention group had significantly shorter hospital stay than in the non-intervention group（P0.05）;there were no statistical differences between the two groups in the costs for antibiotics（P0.05）.CONCLUSION：After intervention,the irrational use of prophylactic antibiotics for patients undergoing type II incision operation become significantly less frequent,and medical workers have attached greater importance to the use of antibiotics.The intervention is of great importance to further standardizing rational use of antibiotics and reducing the occurrence of bacterial drug resistance.