清洁切口围术期预防使用抗菌药物的管理成效分析

Effectiveness of management of prophylactic use of antibiotics during perioperative period of clean incision surgery

目的为规范清洁切口围术期预防使用抗菌药物,探索有效的干预措施,了解干预效果,促进抗菌药物围术期的合理应用。方法对2011年7月-2013年12月医院所有清洁切口手术患者进行目标监测,按照卫生行政管理部门抗菌药物整治方案的要求,结合医院实际,成立相应组织,制定操作性强的推进措施,强化管理,抓好落实,进而评价干预效果;采用SPSS10.0进行统计分析,计数资料采用χ2检验。结果通过综合干预,清洁切口手术患者抗菌药物预防用药使用率明显下降,由2011年7月的90.26%下降至2013年12月的25.12%,差异有统计学意义(P<0.01);术前30min^2h给药率持续升高,由2011年7月的81.33%升至2013年12月的94.29%,差异有统计学意义(P<0.01);术前30min^2h给药率持续升高,由2011年7月的81.33%升至2013年12月的94.29%,差异有统计学意义(P<0.01);预防使用抗菌药物时间≤24h的比例持续升高,由2011年7月的6.22%升至2013年12月的68.57%,差异有统计学意义(P<0.01);清洁切口手术患者预防使用抗菌药物的天数持续缩短,由2011年7月的5.2d缩短至2013年12月的1.49d;特别是抗菌药物品种的选择,由原来经验性或习惯性使用头霉素类、三代头孢或加酶抑制剂等,到现在可以规范使用一、二代头孢菌素。结论通过抗菌药物围术期应用的综合干预,抗菌药物预防用药明显规范。

OBJECTIVE To standardize the prophylactic use of antibiotics during perioperative period of clean inci- sion surgery, explore effective intervention measures, and understand the intervention effect so as to promote the reasonable use of antibiotics during the perioperative period. METHODS The targeted monitoring was performed for all the patients who underwent the clean incision surgery in the hospital from Jul 2011 to Dec 2013, then the corresponding organizations were set up according to the requirements of rectification for antibiotics by the health administrative departments with the combination of the actual reality of the hospital, and highly workable meas- ures were formulated to promote the implementation, the management was intensified, the intervention effect was evaluated, the statistical analysis was performed with the use of SPSS10.0, and the count data were analyzed by using the chi-square test. RESULTS Through the comprehensive intervention, the utilization rate of antibiotics of the patients undergoing the clean incision surgery was significantly reduced, decreasing from 90.26 % in Jul 2011 to 25.12% in Dec 2013, the difference was significant （P〈0.01）. The administration rate at 30 min-2 hours be- fore the surgery was persistently elevated, increasing from 81.33% in Jul 2011 to 94.29 % in Dec 2013, the differ- ence was significant （P〈0.01）; the administration rate at30 min-2 hours before the surgery was persistently ele- vated, increasing from 81.33% in Jul 2011 to 94.29% in Dec 2013, the difference was significant （P〈0.01）. The proportion of the patients with the time of prophylactic use of antibiotics no more than 24 hours continued to rise, increasing from 6.22% in Jul 2011 to 68.57% in Dec 2013, the difference was significant（P〈0.01）. The duration of the prophylactic use of antibiotics was persistently shortened, decreasing from 5.2 days in Jul 2011 to 1.49 days in Dec 2013. For the choice of antibiotics, the empirical or habitual use of cephamyeins, third generation cephalo- sporins or enzyme-containing inhibitors was administered previously, and until now the standardized use of first or second generation eephalosporins could be performed. CONCLUSION The perioperative prophylactic use of antibi- otics has been significantly standardized through the comprehensive intervention.