疝修补术围手术期预防用抗菌药物干预对照研究

Antibiotics Use in Perioperative Period of Hernioplasty by Intervention-control Study

目的探讨疝修补术围手术期预防用抗菌药物的合理性,为规范抗菌药物临床应用管理提供依据。方法将2010年1月-10月出院的168例疝修补术患者围手术期预防用抗菌药物调查情况作为对照,对2011年同期入院的171例患者进行干预。结果干预前后抗菌药物选择前3位的药物由阿洛西林、美洛西林、氨曲南调整为头孢唑林、克林霉素和阿洛西林;首次预防用药时间主要从术前不用术后开始用调整为术前30 min内或麻醉诱导开始时给药;术后用药疗程由(3.50±2.07)d降至(0.88±1.07)d,差异有统计学意义(t’=14.601,P=0.000);术后住院时间由(5.17±1.90)d缩短至(3.77±1.61)d,差异有统计学意义(t’=7.313,P=0.000);抗菌药物治疗费用由(342.39±415.50)元降至(54.08±80.83)元,差异有统计学意义(t’=8.831,P=0.000);抗菌药物治疗费用占药费的比例由(47.53±25.51)%降至(12.49±13.46)%,差异有统计学意义(t’=15.776,P=0.000);抗菌药物治疗费用占住院费用的比例由(6.59±5.49)%降至(1.07±1.35)%,差异有统计学意义(t’=12.662,P=0.000);干预前后预防用药选择、术前给药时机、术后用药疗程及联合用药无指征等不合理用药表现形式差异均有统计学意义(P<0.05)。结论通过干预,提高了疝修补术预防用抗菌药物的合理性,减少了术后住院时间以及抗菌药物治疗费用。

Objective To evaluate rational use of antibiotics for hernioplasty in perioperative period by intervention- control study in order to provide a foundation for the clinical antibiotic use and management. Methods The data of the preventive use of antibiotics for hernia patients from January to October, 2010 in perioperative period were collected and compared. Interventions on patients from January to October, 2011 were carried out. Results In the intervention group, the first three antibiotics used were changed from azlocillin, mezlocillin and aztreonam before intervention to cefazolin, clindamycin and azlocillin after intervention. Before intervention, antibiotics were first used after surgery for surgical prophylaxis, while after intervention, antibiotics were first used within 30 minutes before surgery or at the start of induction of anesthesia. The preventive medication time decreased from （3.50 -± 2,07） days to （0.88 ± 1.07） days （t＇=14.601, P=0.000）, the hospitalization days of post-surgery decreased from （5.17 ± 1.90） days to （3.77 ± 1.61） days （t＇=7.313, P=0.000）, the cost of antibiotics decreased from （342.39 ± 415.50） yuan to （54.08 ± 80.83） yuan （t＇=8.831, P=0.000）, the percentage of the cost of antibiotics in expenses for medicine declined from （47.53 ± 25.51）% to （12.49 ± 13.46）% （t＇=15.776, P=0.000）, and the percentage of the cost of antibiotics in hospitalization expenses declined from （6.59 ± 5.49）% to （1.07 ± 1.35）% （t＇=12.662, P=0.000）. The difference in inappropriate use of antibiotic drugs before and after prevention, such as choice of preventive drugs, preoperative medication occasion, course of postoperative medication and no indication of drug combination, had statistical significances （P 〈 0.05）. Conclusion The intervention-control study shows that the rational use of antibiotics for hernioplasty in perioperative period can be improved, and the average hospitalization days and the cost of antibiotics can be reduced by intervention.