某院持续干预围术期预防用抗菌药合理应用的效果评价

Effect Evaluation of Continuous Intervention on Perioperative Prophylactic Application of Antibacterials

目的:调查某院实施持续干预前后清洁手术和介入术预防用抗菌药(简称"预防用药")的应用情况,为临床合理预防用药提供参考。方法:随机抽取2011年1季度～2012年3季度行甲状腺手术、腹股沟疝修补术、乳腺手术、骨折内固定装置取出术、冠状动脉造影术患者,根据干预时间和干预措施分别纳入干预前组(n=208)、第1阶段干预组(n=176)、第2阶段干预组(n=449)和第3阶段干预组(n=341),对各组患者的预防用药情况进行统计分析。结果:实施持续干预后,第1阶段干预组、第2阶段干预组和第3阶段干预组的预防用药率由干预前的100%降至49.4%,16.2%和9.1%,预防用药的选药合理率由干预前的46.2%升至62.1%,72.6%和96.8%,预防用药时间由干预前的(5.7±2.5)d缩短至(2.5±1.8)d,(2.0±1.4)d和(1.8±1.0)d,差异均具有统计学意义(P<0.01)。感染发生率从干预前的2.4%分别降至1.7%,1.3%和0.9%。结论:该院持续干预措施得力,干预效果显著,明显促进了围术期预防用药合理性。

Objective：To evaluate the effect of continuous intervention performed by clinical pharmacists on perioperative prophylactic application of antibacterials to provide reference for the rational antibacterials use during perioperative period.Method：Totally 1174 cases of discharged patients with thyroid surgery,breast surgery,inguinal hernia surgery,fracture fixation device removal surgery and coronary angiography from January 2011 to September 2012 were selected randoinly and divided into three intervention groups and non-intervention group.The rationality of prophylactic application of antibacterial was compared before and after the intervention.Result： After the continuous intervention,the prophylactic application rate of the first phase,the second phase and the third phase in the intervention groups was significantly decreased from 100%before the intervention to 49.4%,16.2%and 9.1%,respectively.The rationality rate of prophylactic application was significantly improved from 46.2%before the intervention to 62.1%,72.6%and 96.8%,respectively.The course of preventive medication treatment was significantly decreased from（5.7±2.5） days to（2.5±1.8）,（2.0±1.4） and（1.8±1.0） days,respectively（P 0.01 ） with the decreased postoperative infection rate from 2.4%to 1.7%,1.3%and 0.9%,respectively.Conclusion：The pharmaceutical intervention of our hospital is feasible and valid to improve rational use of prophylactic drugs.