我院2年间骨科髋关节置换术预防性应用抗菌药物的临床评价

Clinical Evaluation of Prophylactic Application of Antibiotics in Hip Replacement in Orthopedics Department of Our Hospital during 2 Years

目的:评价我院骨科髋关节置换术预防性应用抗菌药物整治活动的效果,以期逐步扩大抗菌药物专项整治成效,建立长效管理机制。方法:随机抽取我院骨科行髋关节置换术患者182例,其中2010年4月-2011年4月(整治活动前组)90例,2011年11月-2012年11月(整治活动后组)92例。对患者的自然情况、抗菌药物使用品种、使用时机、使用疗程等进行汇总及评价,并将结果应用SPSS 18.0软件进行统计分析,比较两组患者预防性应用抗菌药物的合理性。结果:开展抗菌药物专项整治后,抗菌药物预防性应用主要药物由第3代头孢菌素(31.11%)变为第1代头孢菌素(54.35%),其他各类药物的使用率均有显著下降(P<0.01);预防用药时机由大于术前2 h(58.89%)变为切皮前0.5~2 h(88.04%);用药疗程由平均(11.91±3.87)d变为(4.07±2.32)d;抗菌药物平均总费用下降71.06%。经过整治活动后药物选择不合理、术前用药不合理、更换药物不合理以及联合用药不合理的情况均有显著下降(P<0.01)。结论:抗菌药物专项整治活动后,我院骨科髋关节置换术预防性应用抗菌药物合理性得到明显改善,抗菌药物合理应用的长效管理机制已逐步建立。

OBJECTIVE： To evaluate the effects of prophylactic application of antibiotics in hip replacement in orthopedics de- partment of our hospital, and to gradually expand antibiotics rectification and set up a long-term management mechanism. METH- ODS： 182 cases of hip replacement were collected, among which there were 90 cases during Apr. 2010--Apr. 2011 （before rectifi- cation） and 92 cases during Nov. 2011--Nov. 2012 （after rectification）. The natural condition of patients, varieties of antibiotics, medication timing, treatment course and so on were summarized and evaluated. The results were analyzed statistically using SPSS 18.0 software. The prophylactic use rationality of antibiotics was compared between 2 groups. RESULTS： After antibiotics special rectification, the prophylactic application of antibiotics were first-generation cephalosporins （54.35%） replacing of third-generation cephalosporins （31.11% ） ; utilization raie of drugs were decreased significantly （P〈0.01 ） ; antibiotics were used 0.5-2 h before in- cision （88.04%） instead of 2 h before operation （58.89%） ; treatment course lasted for （4.07 ＋ 2.32） days instead of （11.91 ＋ 3.87） days; average cost of antibiotics decreased by 71.06%. After special rectification, irrational selection of drugs, irrational pre- operative medication, irrational drug replacement and irrational drug combination were decreased significantly （P^0.01）. CON- CLUSIONS： After antibiotics special rectification, prophylactic application of antibiotics in hip replacement has been improved sig- nificantly; long-term management mechanism on the rationality of antibiotics use has been gradually established.