口腔颌面部手术围术期预防性抗菌药物应用现状的分析

Analysis of current situation of perioperative prophylactic antibiotics in oral and maxillofacial surgery

目的调查口腔颌面部清洁手术、清洁-污染手术围术期抗菌药物应用及感染情况,评估用药合理性。方法随机性回顾分析西安交通大学口腔医院口腔颌面外科自2010年1月至2012年12月清洁手术住院病历411例,清洁-污染手术住院病历275例,分别从联合用药、用药时间、用药类型、伤口感染、细菌培养等方面进行统计,应用SPSS 18.0软件对数据进行分析。结果清洁手术预防性抗菌药物使用率88.81%,其中单剂用药占38.63%,用药时间小于24小时所占比例为12.33%;清洁-污染手术抗菌药物应用率100%,其感染率高于清洁手术(P=0.039),以清洁-污染肿瘤手术为主(P=0.001),单剂用药伤口感染率高于双联用药(P=0.019)。结论根据抗菌药物应用相关指导原则,清洁手术预防性抗菌药物使用是过度的。清洁-污染肿瘤手术患者是感染好发群体,覆盖革兰氏阳性菌、革兰氏阴性菌的抗菌药物制剂组合优于单剂。

Objective To investigate the perioperative prophylactic antibiotics application and infection status in oral and maxillofacial clean, clean-contaminated surgery, and evaluate the rationality. Methods From January 2010 to December 2012, 411 cases of clean surgery and 275 cases of clean-contaminated surgery was performed a retrospective analysis. Clinical data including combination of the medication, time of medication, medication types, wound infection, bacterial culture and the results were analyzed using SPSS18.0. Results In clean surgery ,prophylactic antibiotics were applied for 365 patients （88.81%）, of which 141 cases （38.63%） were single species and medication duration less than 24 hours accounted for 12.33%. Prophylactic antibiotics were used for all clean-contaminated surgery, the wound infection rate of clean-contaminated is higher than that of the clean surgery （P=0.039）, of which clean-contaminated cancer surgery is the high-risk groups （P=0.001）. In the group of single species, wound infection rate is higher than of the group of two species, there was a statistical difference between the two groups （P=0.019）. Conclusion According to the antimierobial application guidelines, antibiotic prophylaxis was excessively used for the clean surgery. Clean-contaminated cancer surgery is the high-risk groups. Combination of antibiotic for coverage of gram-positive bacteria and gram-negative bacteria is superior to single-agent.