320例肿瘤患者围术期预防应用抗菌药物调查分析

Perioperative prophylactic use of antibiotics by 320 tumor patients

目的了解肿瘤患者围术期抗菌药物的应用,为加强抗菌药物的合理使用和规范管理提供依据。方法随机抽取医院2011年9月-2012年3月外科肿瘤手术患者出院病历320份,进行围术期抗菌药物应用统计、分析。结果 320例肿瘤手术患者中,Ⅰ类切口手术168例,抗菌药物使用率为52.5%,Ⅱ类切口手术152例,抗菌药物使用率为47.5%;术前给药时机正确率为93.7%;在17例手术时间>3h的患者中,无1例于术中追加抗菌药物;围手术期抗菌药物以一联用药为主;平均用药疗程Ⅰ类切口手术1.9d、Ⅱ类切口手术5.6d;所选预防用抗菌药物中,头孢菌素类占80.8%。结论医院Ⅰ类切口围术期预防用药存在使用率较高、起点偏高、用法及用量不合理、用药指征把握不严、疗程过长等问题;Ⅱ类切口围术期预防用药存在使用疗程过长等问题,应合理地预防性使用抗菌药物,进一步加强抗菌药物的分级管理使用。

OBJECTIVE To investigate the status of perioperative prophylactic use of antibiotics by the tumor patients so as to offer evidence for reinforcing the rational use and standard management of antibacterial agents.METHODS A total of 320 medical records of discharged patients who underwent tumor resection from Sep 2011 to Mar.2012 were randomly sampled for statistical analysis in respect of the perioperative prophylactic use of antibiotics.RESULTS Of 320 patients undergoing the tumor resection,there were 168 patients who underwent the type I incision surgery with the utilization rate of antibiotics of 52.5% and 152 patients who underwent the typeⅡ incision surgery with the utilization rate of antibiotics of 47.5%.The positive rate of administration time was 93.7%.Among 17 patients whose duration of operation was longer than 3 hours,no one received an additional intraoperative antimicrobial dose.The ratio of patients using antibiotics was 51.8% and the average course of treatment was 1.9 days for type I incision versus 100% and 5.6 days for type Ⅱ incision.Of the antibiotics used,the cephalosporins accounted for 80.8%.Drugs were used mainly in single dosage.CONCLUSION The problems such as high proportion of high grade drugs,irrational use in dosage and administration,not confirming medication indicator,prolonged application for type I incision and prolonged application for type Ⅱ incision exist in the perioperative prophylactic use of antibiotics,and the problems should be further standardized.