临床药师干预普外科Ⅰ类切口手术预防性应用抗菌药物效果分析

Effectiveness of Clinical Pharmacists ' Intervention on Prophylactic Use of Antibiotics for Surgical Patients undergoing Type Ⅰ Incision Surgery

目的：探讨河池市东兰县人民医院临床药师对普外科Ⅰ类切口手术预防性应用抗菌药物的干预作用及效果.方法：收集2010年5月-2011年4月（干预前）普外科出院病例205例,设为非干预组;干预分为2个阶段,2011年5月-2012年4月为干预的第1阶段,收集此阶段普外科出院病例251例;2012年5月-2013年4月为干预的第2阶段,收集此阶段普外科出院病例263例,对干预前后普外科Ⅰ类切口手术预防性应用抗菌药物的合理性进行比较.结果：第一阶段干预后,抗菌药物使用率由干预前的100％下降为99.6％,疗程由干预前的5～14 d（平均8.39 d,且出院还带口服抗菌药物）下降为1～8d（平均2.8d）,未用抗菌药物者已有1例,疗程≤24 h、25 ～48 h的比例从零到明显提升,疗程≤24 h的比例已达40.64％,疗程为3～7d、＞7d的比例明显下降,用药选择、给药时间、术中用药、用法与用量逐步合理,联合用药、给药途径全部合理;第二阶段干预后,抗菌药物使用率由干预前的100％下降为5.70％,且后阶段有用药指征的患者也不预防性用药,疗程为0～1d（平均0.057 d）,其余各项也全部合理且切口甲级愈合、无感染.结论：临床药师对普外科Ⅰ类切口手术预防性应用抗菌药物的干预效果显著,全部达到2012年全国“抗菌药物临床应用专项整治活动”方案的要求.

OBJECTIVE：To evaluate the role and effectiveness of clinical pharmacists＇ intervention on the prophylactic use of antibiotics in surgical patients undergoing type Ⅰ incision surgery in Hechi Donglan County People＇s Hospital.METHODS：205 discharged surgical cases from May 2010 to April 2011 （before intervention） were assigned to non-intervention group and 251 discharged surgical cases collected during stage Ⅰ （from May 2011 to April 2012） vs.263 discharged surgical cases collected during stage Ⅱ （from May 2012 to April 2013） were assigned to intervention group.The rationality in the prophylactic use of antibiotics in surgical patients undergoing type Ⅰ incision surgery before and after intervention was compared.RESULTS：After stage Ⅰ intervention,the proportion of patients administered with antibiotics reduced from 100％ （before intervention） to 99.6％ （after intervention） and the course of treatment was reduced from 5-14 days before intervention （an average of 8.39 days,with discharge medication of oral antibiotics） to 1-8 days （an average of 2.8 days）; antibiotics were not used in 1 case; the proportion of patients administered with antibiotics for ≤24 hours for 25-48 hours showed sharp increase from 0％ ; the proportion of patients administered with antibiotics for ≤24 hours has reached 40.64％ ; the proportion of patients administered with antibiotics for 3-7 days or ＞ 7 days showed a sharp decrease ; the drug choice,administration time,intraoperaitve medication,dosage ＆ administration became more and more rational,and drug combination and routes of administration were completely rational.After stage Ⅱ intervention,the proportion of patients administered with antibiotics reduced from 100％ （before intervention） to 5.70％ （after intervention） and even the patients with medication indications had no prophylactic use of antibiotics in the later stage ; the course of treatment was 0-1 day （an average of 0.057 days）,and all the other antibiotic use indicators were rational with grade A healing of incision （without infection）.CONCLUSION：Clinical pharmacists＇ intervention on the prophylactic use of antibiotics in surgical patients undergoing type Ⅰ incision surgery achieved noticeable effectiveness and met the requirement of ＂special rectification activities in 2012 on clinical application of antibacterial drugs＇.