急诊科老年胸部创伤患者抗菌药物预防性使用的不合理因素分析

Factors for unreasonable antibiotic prophylaxis of senile patients with chest trauma in emergency department

目的分析急诊科老年胸部创伤患者抗菌药物预防性使用的不合理因素,并提出应对措施,以进一步规范合理应用抗菌药物。方法选取近年来某院急诊科治疗的老年胸部创伤患者作为研究对象,对患者临床资料进行回顾性分析,观察患者治疗过程中预防使用抗菌药物情况,总结存在的不合理因素,并提出应对措施。结果经过治疗,有247例患者临床治愈,治愈率为66.0%;好转患者81例,好转率为21.7%;死亡46例,病死率为12.3%;期间共发生感染83例,感染率为22.2%;共有287例患者使用抗菌药物预防性治疗,使用率达76.7%;其中不合理应用为89例,不合理应用率达31.0%;抗菌药物不合理使用因素主要为无指征用药占19.1%、用药时机选择不对占18.0%和药物选择不合理占13.5%;由于抗菌药物不合理使用发生感染43例,占感染总数的51.8%。结论通过对老年胸部创伤患者抗菌药物预防性使用情况进行分析,针对存在的不合理因素进行有效控制,能够为老年胸部创伤患者合理使用抗菌药物进行预防性治疗提供可靠依据,对于减少抗菌药物的滥用和保障患者健康具有重要意义。

OBJECTIVE To analyze the factors for the unreasonable antibiotic prophylaxis of the senile patients with chest trauma in the emergency department and put forward the corresponding measures so as to further standardize the use of antibiotics. METHODS The senile patients with chest trauma who were treated in an emergency department in recent years were enrolled in the study; then the clinical data of the patients were retrospectively analyzed; the prophylactic use of antibiotics during the treatment was observed, the factors for unreasonable use of antibiotics were summarized so as to put forward the corresponding measures. RESULTS After the treatment, 247 patients were cured clinically with the cure rate of 66.0%, 81 cases were improved with the recovery rate of 21.7%; 46 cases died with the mortality of 12.3%. The infections occurred in 83 cases during the survey period with the infection rate Of 22.2%. Totally 247 cases of patients used prophylactic antibiotics with the utilization rate of 76.7%, among which ：Lhere were 89 （31.0%） cases who used unreasonably; the use of antibiotics without indications was the predominant factor （19.1%）, followed by the inappropriate medication timing （18.0%） and unreasonable selection of antibiotics （13.5%） ; the infections occurred in 43 （51.8%） cases due to the unreasonable use of antibiotics. CONCLUSION Through the analysis of prophylactic use of antibiotics of the senile patients with chest trauma and the control of the factors for unreasonable use of antibiotics, the reliable bases can be provided for the prevention prophylaxis, which is of great significance to reduce the abuse of antibiotics and ensure the patients＇ health.