2730例剖宫产围手术期抗菌药物预防使用存在问题分析

Problem analysis of preventive usage of antibiotics in 2730 cases of cesarean sections in perioperative period

目的：通过探讨我院剖宫产手术抗菌药物的应用存在的问题，提高医院合理应用抗菌药物水平，降低手术部位的感染率。方法采用回顾分析法统计分析了2013年1月～2014年9月我院妇产科2730例剖宫产患者围手术期抗菌药物应用情况。结果我院2730例患者预防剖宫产手术感染术后应用抗菌药物比率100%。单用一种抗菌药物预防者1723例（63.11%），应用两种抗菌药物预防者1007例（36.89%），无预防应用三种或三种以上抗菌药物的现象。抗菌药物使用时间为2～7d，使用5d 者最多。抗菌药物预防应用最多的是阿莫西林克拉维酸钾。两种抗菌药物联合预防应用最多的是注射用头孢呋辛和奥硝唑注射液。合理应用抗菌药物的评价中剖宫产手术预防合理者648例（23.74%），不合理占2082例（76.26%）。结论剖宫产手术预防应用抗菌药物存在很多不合理现象，主要体现在选择抗菌药物品种不合理、给药剂量和间隔与说明书规定不符合、选择溶媒错误或溶媒体积过大、预防给药术后输注、预防使用疗程过长、联合应用抗菌药物不合理，并且有多份病历中存在多个不合理用药问题，建议剖宫产手术预防应用抗菌药物按《抗菌药物临床应用指导原则》和《围手术期预防应用抗菌药物指南》加以干预。

Objective To explore the problems of prophylaxis usage of antibiotics in cesarean sections to improve rational use of antibiotics and reduce the rate of surgical sites infection. Methods Retrospective analysis of antibiotics usage for 2730 cases of cesarean sections in perioperative period in our hospital from January 2013 to September 2014 was made. Results The rate of using antibiotics to prevent infections after cesarean sections among 2730 cases was 100%. There were 1723 cases which were used single type of antibiotics （63.11%）, 1007 cases which were used two types of antibiotics （36.89%） and no cases which were using three or more types of antibiotics. The usage of antibiotics last 2 to 7 days, and most of them used for 5 days. The most frequently used preventive antibiotics was Amoxicillin and Clavulanate Potassium, and the most frequently two combined used preventive antibiotics were cefuroxime for injection and ornidazole injection. In the evaluation on rational usage of antibiotics, 648 cases were prevented rationally in the cesarean sections （23.74%）, and 2082 cases were irrationally prevented （76.26%）. Conclusion There exists numerous irrational preventive usage of antibiotics in cesarean sections, including irrational choice of antibiotics, non-conformance between administration dosage and interval and package insert, wrong choice or overlarge volume of solvent, postoperative infusion of prophylaxis antibiotics, too long prophylaxis usage course, irrational combined application of antibiotics and irrational administration in numerous medical records. It is suggested that prophylaxis usage of antibiotics in cesarean sections should be interfered with guiding principles of clinical use of antibiotics and guide of perioperative preventive application of antimicrobial agents.