外科清洁手术预防性抗菌药物的合理应用

Reasonable antibiotics prophylaxis for clean surgery

目的分析专家组现场点评住院医嘱前后医院外科清洁手术预防性抗菌药物的应用,并对其合理性做出评价。方法随机抽查医院普通外科、骨科、神外科及胸外科清洁手术病历,专家组现场点评住院医嘱前2011年1-6月为甲组,专家组现场点评住院医嘱后2012年1-6月为乙组,每组各150份病历,比较两组用药比例及用药指征、用药时机、药物的选择不合理等指标。结果清洁手术围手术期抗菌药物使用率从现场点评前的91.33%下降至现场点评后的28.67%(χ2=122.7,P<0.01);各项不合理用药指标明显下降(P<0.01)。结论在多部门联动,加强围手术期抗菌药物使用环节管理等一系列措施的基础上,专家组现场点评住院医嘱具有可行性和有效性。

OBJECTIVE To observe the prophylactic use of antibiotics for clean surgery and evaluate the rationality before and after the specialists reviewed hospitalized prescriptions. METHODS The medical records of undergoing cleaning surgery in the general surgery department, orthopedics department, neurosurgery department, and thoracic surgery department were randomly reviewed and divided into the group A （before the specialists reviewed the prescriptions, from Jan to Jun, 2011） and the group B （after the specialists reviewed the prescriptions, from Jan to Jun, 2012）, with 150 medical records in each; then the medication proportion, medication indications, medication timing, and unreasonable use of antibiotics were observed and compared between the two groups. RESULTS During the perioperative period of clean surgery, the utilization rate of antibiotics decreased from 91.33% before the onsite review to 28.67 % after the onsite review （%2 = 122.7, P〈0.01） ; the indicators for the unreasonable medication were significantly reduced （P〈0.01）. CONCLUSION The on-site reviews of the specialists are feasible and effective based on a series of management measures including the multi-sector cooperation and enhancement of link of use of antibiotics during the perioperative period.