药学干预对Ⅰ类切口手术预防性用药合理性的影响

Impact of Pharmaceutical Intervention on The Rationality of Prophylactic Use of Antibiotics in Patients Undergoing Type Ⅰ Incision Operation

目的:了解河南科技大学附属黄河医院Ⅰ类切口手术围术期预防性应用抗菌药物的合理性,研究药学干预对其的影响。方法:以随机抽样法调取干预前(2008年1月—2009年12月)和干预后(2010年1月—2011年12月)Ⅰ类切口手术(疝气手术、乳腺手术和甲状腺手术)病历各150份,对抗菌药物预防性使用率、给药时间合理率、疗程合理率、无指征用药比例和抗菌药物品种选择合理率等指标进行统计分析。结果:干预后抗菌药物预防性使用率显著下降,由干预前的74.50%下降为干预后的48.00%;给药时间和疗程合理率明显上升,干预后术前30 min用药率达100%,术后用药时间超过24 h的比例由干预前的68.47%下降至干预后47.22%;无指征用药比例明显下降,由干预前的44.67%下降至干预后的38.00%;选药合理率上升,使用广谱抗菌药物的比例由干预前的48.65%下降至干预后的16.67%。经过药学干预,不合理使用抗菌药物的现象明显改善。结论:采取有效的药学干预措施,可显著提高抗菌药物的合理使用率,降低抗菌药物费用,为医院设计单病种临床路径及降低单病种费用提供依据。

OBJECTIVE ： To investigate the rationality in perioperative use of antibiotics in patients undergoing type I incision operation in Henan University of Science and Technology Affiliated Huanghe Hospital and the impact of pharmaceutical intervention on it. METHODS： By a random sampling method, the medical records of patients undergoing three different type I incision operations （hernia operation, breast operation and thyroid operation） were collected from Jan. 2008 to Dec. 2009 （before intervention, 150 cases） and from Jan. 2010 to Dec. 2011 （after intervention, 150 cases） for statistical analysis with regard to the rate of prophylactic use of antibiotics, rates of rational time and duration of administration, rate of non-indication use and rate of rational choice of antibiotics etc. RESULTS： After intervention as against before intervention, the rate of prophylactic use of antibiotics decreased from74. 50% to 48.00% ; the rates of rational time and duration of administration increased significantly, with all （100%） used drugs 30 rain before operation and 47.22% used antibiotics for more than 24 hrs as against 68.47% did before intervention; the rate of non-indication use of antibiotics decreased from 44. 67% to 38.00% ; the rate of rational choice of antibiotics increased, with the rate of using broad-spectrum antibiotics down from 48.65% to 16.67%. Through pharmaceutical intervention, the non-rational use has been greatly improved. CONCLUSION： Taking effective pharmaceutical intervention greatly contributed to the increase of rational use of drugs and decrease of antibiotic cost, which provide basis for designing clinical ar）proach for and cost reduction of single disease.