Ⅰ类切口手术抗菌药物预防使用干预研究分析

Research on interventions to prophylactic use of antibiotics for type Ⅰ incision surgery

目的通过规范普外科Ⅰ类(清洁)切口手术围手术期预防使用抗菌药物的管理,观察其减少细菌耐药,降低医药费用,促进合理用药的效果。方法随机研究调取乐清市2009年5月-2010年5月的Ⅰ类切口归档病历360份作为分析对象,设为对照组;2010年5月开始,对乐清市三所医疗机构进行抗菌药物合理使用的管理,随机调取2010年6月-2011年8月的Ⅰ类切口归档病历360份作为研究对象,设为观察组,将两组患者的详细资料进行信息收集,依次填写自行设计的研究调查表;比较两组在抗菌药物应用方面存在的差异。结果对照组360例均采用了抗菌药物的预防性应用,使用率为100.0%,其中321例为单一用药,占89.2%,39例为二联用药,占10.8%;术前规范性应用抗菌药物者241例,占66.9%,在术后规定时间内停止使用抗菌药物者137例,占38.1%;观察组360例,301例患者实施了抗菌药物的预防性应用,使用率为83.6%,其中291例为单一用药,占96.7%,20例为二联用药,占3.3%;术前规范性应用抗菌药物者261例,占86.7%,在术后规定时间内停止使用抗菌药物者220例,占73.1%,观察组较对照组在合理使用抗菌药物方面具有显著合理性(P<0.05);两组患者在抗菌药物的使用集中度方面差异无统计学意义。结论通过乐清市药事质控中心及各单位相关部门采取有效的干预管理措施,能降低Ⅰ类切口围手术期的抗菌药物预防性使用率、掌握好抗菌药物的使用时机及指征,做到抗菌药物的规范化应用。

OBJECTIVE To study the management by standardizing the use of antimicrobial drugs during perioperative period of typeⅠ （cleaning） incision surgery so as reduce the bacterial resistance, cut the medical cost, and improve the effect of reasonable use of antibiotics. METHODS A total of 360 cases of incision archive records of type Ⅰ rom May 2009 to May 2010 were randomly selected as the study objects and were set as the control group; from May, after the management of reasonable use of antibiotics in the three medical institutions of Yueqing, totally 360 cases of type Ⅰ incision archive record were randomly extracted from Jun 2010 to Aug 2011 and were set as the observation group. The detailed information of the two groups of patients was collected, and the self-designed study questionnaires were in turn filled out; the use of antibiotics was compared between the two groups. RESULTS All the 360 cases in the control group have take the prophylactics use of antibiotics with the utilization rates of 100.0%, among which there were 321 （89.2%） cases who took one-drug medication and 39 （10.8%） cases who used two-drug medication; there were 241 （66.9%） cases who used antibiotics reasonably before the surgery and 137 （38.1%） cases who were withdrawn within predetermined period of time. Of the 360 cases in the observation group, totally 301 cases have taken the prophylactic antibiotics with the utilization rate of 83. 6%, among which there were 291 （96.7%） who took one-drug medication and 20（3.3%） cases who took two-drug medication; there were 261 （86.7%） who used antibiotics reasonably before the surgery and 220 （73.1%） who were withdrawn within the predetermined period of time, the cases in the observation group used antibiotics more reasonably than did the cases in the control group （P〈. 05） ; the difference in the concentration of use of antibioticsbetween the two groups was not statistically significant. CONCLUSION The effective interventions taken by Yueqing City Pharmaceutical Quality Control Center and the relevant departments can reduce the utilization rate of prophylactic antibiotics during the perioperative period of type I incision surgery and master the timing and indications of the use of antirnicrobial agents so as to achieve the standardized use of antibiotics.