剖宫产围手术期抗菌药物使用分析及合理性评价

Analysis and Rationality Evaluation of Application of Antibiotics during Perioperative Period of Cesarean Section

目的:调查医院剖宫产围手术期抗菌药物使用的情况,分析存在的问题及相关原因,并进行合理性评价,为抗菌药物的合理使用和规范管理提供科学依据。方法:回顾性调查2012年1-9月符合遴选标准病例656例,分析手术患者抗菌药物预防应用存在的问题及原因。结果:剖宫产患者100%应用抗菌药物,均为钳夹脐带后静脉给药;联合用药185例,占28.2%;用法用量不合格118例,占18.0%;平均使用抗菌药物天数为(4.52±1.30)d;用药频次从高到低依次为头孢美唑、头孢呋辛、甲硝唑、头孢地嗪、奥硝唑、头孢替安;大部分药物的药物利用指数(DUI)小于或接近1,但头孢地嗪、头孢呋辛、美洛西林DUI明显大于1,存在单次剂量偏大情况。结论:剖宫产围手术期抗菌药物使用明显存在选药起点高,使用疗程长,以及用法用量不当的问题,因此必须加大监管力度,采取多项切实有效的管理措施来规范医院剖宫产围手术期抗菌药物的使用,提高医院的合理用药水平。

Objective：To investigate the application of antibiotics during perioperative period of cesarean section,and analyze the problems and reasons,so as to to provide a scientific basis for the rational use of antibiotics and standardize management.Methods：Retrospective investigation was conducted in 656 cases which met the selection standards from Jan.to Sept.in 2012 to analyze the problems and reasons in the preventive application of antibiotics.Results：Antibiotics were used in all those 656 cases and all were given after the umbilical cord was Clamped.Two kinds of antibiotics were used in 185 cases（28.2%）.There existed wrong usage and dosage in 118 cases（18.0%）.The average using time was for 4.52±1.30 d.Cefmetazole,cefuroxime,metronidazole,cefodizime,ornidazole,and cefotiam were the most frequently used antibiotics in turn.The DUIs of most antibiotics were less than or close to 1,but DUIs of cefodizime,cefuroxime,and mezlocillin were greater than 1,and the single dose of them were too high.Conclusion：The main problems of antibiotics used in our hospital were as followings：application of high-class drugs,long course of treatment,and wrong dose and method.A number of intervention measures should be taken to optimize the antibiotics application during perioperative period of cesarean section,so as to improve the rational use of drugs in hospital.