神经外科清洁切口手术围手术期预防用抗菌药物调查分析

Perioperative application of prophylactic antibacterial drugs in neurosurgery clean incision operation

目的：调查某三甲医院神经外科Ⅰ类切口手术预防性应用抗菌药物使用情况，并评价其用药合理性，为抗菌药物的临床应用管理提供数据支持。方法回顾性调查某三甲医院2012年1月～12月神经外科126例Ⅰ类切口手术有关抗菌药物的预防性应用情况并进行合理性评价。结果126例神经外科清洁手术患者中，117例使用了抗菌药物，使用率92．86％，除有10例为两联用药外，均为单一用药。在初次给药时机方面，术前0．5～2 h、2～24 h和大于24 h用药者分别为40例、8例、13例，术后用药者56例。在术后持续给药方面，用药时间小于1 d者为0，用药1～3 d、4～7 d、大于7 d者分别为10例、42例和65例。平均抗菌药物费用为1176．29元。综合评价用药合理性，不合理用药率为100％。结论该院神经外科I类切口手术围手术期预防使用抗菌药物存在抗菌药物选择不当、用药时机不当及用药疗程过长等不合理应用问题，需加强管理及行政干预。

Objective To investigate the use of prophylactic antibacterial drugs used in neurosurgery clean incision opera -tion and evaluate its rationality ,so as to provide data support for the management of clinical application of antibacterial drugs . Methods 126 patients with type I neurosurgery incision operation from January to December 2012 were sampled .The general data and drug application of the patients were analyzed statistically by a questionnaire .Results Among all the 126 cases,117 used antimicrobial agents for prophylaxis ,the utilization rate was 92.86%.All of the cases were single medicine use except 10 cases of two couplet medicines .In terms of initial dosing time ,40 cases,8 cases,13 cases were 0.5 ~2 hours,2~24 hours, and more than 24 hours respectively before operation .56 patients were given medication after surgery .In terms of postoperative continuous dose,no cases used medicine less than 1 day,while 10 cases,42 cases and 65 cases continued 1~3 days,4~7 days,and more than 7 days respectively .The average antibacterial drug cost was 1176.29 yuan.Under comprehensive drug use rationality evaluation ,the rate of irrational drug use was 100%.Conclusion Unreasonable perioperative drug application of preventive antimicrobial agents in neurosurgery type I incision surgery exists in this hospital .The problems include improper antimicrobial drug selection , improper drug use time and a too long course of administration .It is necessary to strengthen man-agement and administrative intervention .Cooperation from doctors ,and understanding and support from patients and their fami-lies are necessities to achieve the goal of reasonable application of antibacterial drugs .