临床药师持续干预泌尿外科清洁手术预防用抗菌药合理使用的效果评价

Effect Evaluation of Continuing Intervention on Prophylactic Application of Antibiotics in Sterile Operation in Urology Department by Clinical Pharmacist

目的：调查某院临床药师实施持续干预前后泌尿外科清洁手术预防用抗菌药（简称＂预防用药＂）的应用情况,为临床合理预防用药提供参考。方法：提取我院泌尿外科2010年7月~2014年6月所有行清洁手术患者,根据干预时间和干预措施分别纳入干预前组（n=141）、第1阶段干预组（n=139）、第2阶段干预组（n=162）和第3阶段干预组（n=137）,对各组患者的预防用药情况进行统计分析。结果：实施持续干预后,第1阶段干预组、第2阶段干预组和第3阶段干预组的预防用药率由干预前的100%降至34.5%,18.5%和14.6%,预防用药的选药合理率由干预前的36.9%升至58.3%,63.3%和85.0%,预防用药时间由干预前的（138.2±31.6）h缩短至（89.9±48.0）h,（72.8±32.5）h和（45.1±29.5）h,差异均有统计学意义（P〈0.01）。感染发生率呈下降趋势,从干预前的2.8%分别降至2.1%,1.8%和1.4%。结论：临床药师的持续干预措施得力,干预效果显著,明显促进了泌尿外科清洁手术围手术期预防用药合理性。

Objective ： To evaluate the effect of continuing intervention on prophylactic application of antibiotics in sterile operation in urology department by clinical pharmacist to provide reference for the clinical prophylactic application of antibiotics. Methods： All cases of discharged patients underwent sterile operation in urology department of our hospital from July 2010 to June 2014 were divided into three groups according to the intervention time and methods ： non-intervention group （ n = 141 ）, stage I intervention group （ n = 139）, stage Ⅱ intervention group （n = 162 ） and stage HI intervention group （n = 137 ）. The prophylactic application of antibiotics was statistically analyzed. Results： After the continuing intervention, the prophylactic application rate of antibiotics in the three inter- vention groups was decreased significantly from 100% before the inten;ention respectively to 34.5%, 18.5% and 14.6% after the in- tervention （ P 〈 0.01 ）. The rationality rate of prophylactic application was improved significantly from 36.9% before the intervention respectively to 58.3% , 63.3% and 85.0% after the intervention （ P 〈 0.01 ）. The course of prophylactic application was decreased significantly from （ 138.2 ± 31.6） h respectively to （ 89.9 ± 48.0） h, （72.8 ±32.5 ） h and （ 45.1 ± 29.5 ） h （ P 〈 0; 01 ） and the postoperative infection rate was decreased from 2.8% respectively to 2.1% , 1.8% and 1.4%. Conclusion： The pharmaceutical interven- tion is feasible and valid to improve the rational prophylactic use of antibiotics in urological surgery.