抗菌药物专项整治活动对我院胃部及结直肠手术围术期预防用药的影响

Effects of Antibiotics Special Rectification Activities on the Perioperative Prophylactic Use of Antibiotics in Stomach and Colorectal Operations in Our Hospital

目的:比较抗菌药物专项整治活动期间我院胃肠外科胃部手术、结直肠手术在围术期预防用药的合理性,评价抗菌药物专项整治活动对抗菌药物使用的影响。方法:整群选取整治前阶段组(2010年)、整治1阶段组(2011年)和整治2阶段组(2012年)涉及胃部手术、结直肠手术的全部出院病历,进行整治前后预防用抗菌药物合理性的对照研究,考察整治措施的有效性和可行性。结果:预防用抗菌药物综合不合理率整治2阶段为74.92%,较整治前阶段的96.40%明显降低(P<0.05)。整治1阶段初次预防给药时机较整治前明显改善(P<0.05);整治2阶段组除初次给药时机的合理率明显提高(P<0.05)外,用药疗程、术中追加、联合用药等指标合理率也明显提高(P<0.05)。整治各阶段手术部位感染率差异无统计学意义(P>0.05)。结论:专项整治活动的开展和整治干预措施的出台对胃肠外科胃部及结直肠手术围术期抗菌药物的使用产生了一定影响,尤其是强有力的奖惩措施、强度指标细化控制、开展前瞻性研究等措施更是成效显著。

OBJECTIVE ： To evaluate the impact of antibiotics special rectification activities on the use of antibiotics by comparing the rationality of perioperative prophylactic use of antibiotics in gastric and colorectal surgery. METHODS： A control study about the rationality of perioperative prophylactic use of antibiotics before and after treatment was conducted by cluster sampling all medical records of gastric and colorectal surgery before rectification （2010）, earlier stage after rectification （2011） and later stage after rectification （2012）. RESULTS： Compared with before rectification （96.40%）, the irrational rate of antibiotics in later stage after rectification was 74.92 % and decreased significantly （P〈0.05）. The reasonable rate of medication timing was improved significantly in the earlier stage after rectification （P〈0.05）. The reasonable rates of first medication timing was increased significantly in later stage after rectification （P〈0.05） ; treatment course, intraoperative additional drugs and drug combination were all increased significantly in later stage after rectification （P〈0.05）. But there was no significant difference in the incidence of surgical site infections among three stages （P〉0.05）. CONCLUSIONS： The rectification activities and intervention measures have effects on perioperative prophylactic use of antibiotics in stomach and colorectal operations, especially the punishment measures, the control of density index and prospective study.