抗菌药物使用调查及干预前后对比分析

Investigation of antibiotic use on wards and a comparative analysis of therapeutic efficacy before and after intervention

目的：探讨干预前后病区使用抗菌药物的合理性与干预措施实施的效果。方法采用回顾性调查方法，随机选取2011年7-12月及2012年1-6月每月各30份出院病历，以前者为干预前组，后者为干预后组，围手术期干预前组患者71例和干预后组64例；非手术干预前组患者109例和干预后组116例，分别对围手术期和非手术干预前后患者使用抗菌药物的合理性进行回顾性对照研究，采用 EXCEL2003软件对数据进行统计分析。结果围手术期药物选择、联合用药、给药时机及术后用药时间较干预前均明显改善；药物选择、联合用药不适宜率、分别由32．39％、21．13％下降至17．19％、6．25％；术前未给药、切皮后或术后给药从76．06％下降至48．44％；术后用药24～48 h从13．51％增加至40．63％；术后用药＞72 h从54．93％下降至31．25％，差异均有统计学意义（ P＜0．05）；非手术联合用药较干预前明显改善，联合用药不适宜率由66．67％下降至25．53％，差异有统计学意义（P＜0．05），但抗菌药物平均用药／病例数、细化指标较干预前无明显改善。结论临床药师参与临床合理用药，干预措施有效，因此如何规范化使用抗菌药物成为一个亟待研究和解决的问题。

OBJECTIVE To investigate the rationality of antibiotic use on hospital wards before and after intervention and intervention effect .METHODS Retrospective investigation was conducted to randomly sekected 30 medical records every month from patients discharged Jul .to Dec .2011 and Jan .to Jun .in 2012 .The former was the pre-intervention group;the latter was the intervention group .There were 71 cases and 64 cases before and after intervention during perioperative period .There were 109 cases and 116 cases before and after intervention in non-surgical patients .The total was 360 cases .Respectively ,a retrospective controlled study about perioperative patients and non-surgical patients was done on the rationality of antibiotic use before and after intervention . RESULTS The application of antibiotics was distinctly improved in the choice of medicine , combined use of antibiotics ,prophylactic medication time as well as postoperative medication time as compared with that before the intervention during perioperative period .The irrational use of the choice of medicine and the combined use of antibiotics were decreased from 32 .39% , 21 .13% to 17 .19% , 6 .25% （ P 〈 0 .05 ） . The phenomena of preoperative without medicine and postoperative administration decreased from 76 .06% to 48 .44% （P〈 0 .05） . The postoperative medication time （24-48h） increased from 13 .51% to 40 .63% （P〈0 .05） .The postoperative medication time （＆gt; 72h） decreased from 54 .93% to 31 .25% （P〈 0 .05） .The combined use of antibiotics distinctly improved as compared with that before the intervention in non-surgical patients .The combined use of antibiotics decreased from 66 .67% to 25 .53% （P〈 0 .05） .There were no distinct improvement in the average medication/number of cases and the refinement indicators .CONCLUSION The clinical pharmacists′participating in the intervention in reasonable use of antibiotics is effective .Therefore ,how to regulate the use of antimicrobial agents has become an urgently problem ,w hich needs further study .