综合干预措施提高Ⅱ类切口围手术期预防性应用抗菌药物的合理性

Improving the Rationality of Prophylactic Use of Antibacterials in Perioperative Period of Type Ⅱ Incision Surgery by Comprehensive Intervention Measures

目的:评价和分析综合干预对Ⅱ类切口手术围手术期抗菌药物预防性应用的影响,以促进Ⅱ类切口手术围手术期合理使用抗菌药物。方法:通过行政管理与药学干预相结合的方法,对对照组(2012年出院的Ⅱ类切口手术病例240例)、干预组1(2013年出院的Ⅱ类切口手术病例240例)和干预组2(2014年出院的Ⅱ类切口手术病例240例)围手术期抗菌药物预防性应用情况进行合理性评价及统计学分析。结果:经过综合干预,干预组围手术期抗菌药物使用指标均有明显改善,用药品种选择不适宜从81.25%下降至17.92%和15.24%(P<0.01);术前给药时机不适宜从63.75%下降至12.92%和12.08%(P<0.01);总预防用药时间从(3.04±1.96)d下降至(2.01±1.08)d和(1.98±1.10)d(P<0.01);给药剂量不适宜从10.83%下降至5.00%(P<0.05)和3.75%(P<0.01);干预后未出现无指征和不合理联合用药的情况。结论:通过实施行政管理与药学干预相结合的综合干预措施,可有效提高Ⅱ类切口手术围手术期抗菌药物预防性应用的合理性。

Objective： To evaluate and analyze the effects of comprehensive interventions on the prophylactic use of antibacterials in perioperative period of type Ⅱ incision surgery so as to promote the rational use of antimicrobials in perioperative period of type Ⅱ incision surgery. Methods： By means of administrative management and pharmaceutical intervention, the rationality of prophylactic application of antimicrobials in perioperative period was evaluated and analyzed statistically in control group（240 discharged patients of type Ⅱ incision surgery in 2012）,intervention group 1（240 discharged patients of type Ⅱ incision surgery in 2013） and intervention group 2（240discharged patients of type Ⅱ incision surgery in 2014）. Results： After the comprehensive intervention, the antimicrobial use indicators in perioperative period in the intervention groups were improved significantly, the inappropriate selection of antimicrobial varieties reduced from 81.25% to 17.92% and 15.24%（P 0.01）, the inadequate timing of drug delivery before operation decreased from 63.75% to 12.92% and 12.08%（P 0.01）, the total preventive medication timing decreased from（3.04 ± 1.96） d to（2.01 ± 1.08） d and（1.98 ± 1.10） d（P 0.01）, the improper medicine dosage reduced from 10.83% to 5.00%（P 0.05） and 3.75%（P 0.01） and no-indication and irrational combination of drug use did not appear after the intervention. Conclusion： Through the implementation of administrative management and pharmaceutical intervention as the comprehensive intervention measures, the rationality of prophylactic use of antibacterials can be effectively improved for type Ⅱ incision surgery in perioperative period.