江西省10家三级甲等医院Ⅰ类切口手术预防用抗菌药物持续改进效果分析

Analysis of the Effects of Continuous Improvement of Prophylactic Application of Antibacterial Drugs in TypeⅠIncision Operationin 10 Third-gradeClass-A Hospitals from Jiangxi Province

目的:为进一步提高江西地区医疗机构围术期抗菌药物的合理用药水平提供参考。方法:采用自身对照法,通过摸底调查江西省10家三级甲等医院Ⅰ类切口手术预防用抗菌药物使用现状,进而制订相应整改措施。抽取2009年第1季度Ⅰ类切口手术出院病历共计300份作为对照组,同法抽取2010-2012年每年第1季度的病历分别作为第一阶段干预组、第二阶段干预组和第三阶段干预组,按抗菌药物合理性应用评价标准进行干预前后对照研究。结果:与对照组比较,经3个阶段干预后,Ⅰ类切口手术抗菌药物使用率逐年下降,分别下降至(68.33±3.70)%、(51.33±4.33)%、(35.67±4.94)%;用药疗程在48 h内的合理率从对照组的27.25%提高至干预后的43.85%、62.44%、74.60%;"非限制性使用"类抗菌药物的使用率从对照组的(35.00±4.71)%上升至干预后的(51.86±7.36)%、(77.57±7.14)%、(84.38±6.73)%,差异均有统计学意义(P<0.05)。结论:采取多轮持续性干预措施,可提高围术期抗菌药物应用合理率,保障干预成效的可持续性。

OBJECTIVE： To provide reference for further improving rational use of antibacterial drugs during perioperative period in medical institutions from Jiangxi area. METHODS： Using the self contrast method, prophylactic application of antibacterial drugs in type I incision operation were investigated in 10 third-grade class-A hospitals. And then the corresponding rectification measures were formulated. In the first quarter of 2009, a total of 300 medical records of type I incision operation were included in control group. The medical records were collected from the first quarter of 2010--2012 respectively with same method as the first round intervention group, second round intervention group and third round intervention group. The rationality evaluation standards of antibacterial drugs were studied comparatively before and after intervention. RESULTS： Compared with control group, the utilization ratio of antibacterial drugs in type Ⅰ incision operation decreased year by year after 3 stages of intervention, decreasing to （68.33 ± 3.70）,%, （51.33 ± 4.33） %, （35.67 ± 4.94）%. The reasonable rate of treatment course within 48 h increased from 27.25% of control group to 43.85%, 62.44% and 74.60% of intervention groups. The utilization ratio of ＂non-restricted use＂ antibacterial drugs increased from （35.00 ±4.71 ） % of control group to （51.86 ± 7.36） %, （77.57±7.14） % and （84.38 ± 6.73） % of intervention groups; there was statistical significance （P〈0.05）. CONCLUSIONS： The multiple rounds of persistent intervention measures can improve reasonable rate of perioperative application of antibacterial drugs and guarantee the sustainable intervention effect.