干预前后东莞东华医院骨科Ⅰ类切口手术抗菌药物预防性应用分析

Analysis on Preventive Application of Antibiotics in Type Ⅰ Incision in Department of Orthopedics in Dongguan Donghua Hospital Before and After Intervention

目的：了解干预前后骨科Ⅰ类切口手术预防性使用抗菌药物的变化情况,为进一步规范抗菌药物的合理使用提供参考。方法：采用回顾性统计方法,选取东莞东华医院（以下简称＂我院＂）2011年（干预前）和2013年（干预后）骨科每月1—15日全部Ⅰ类切口手术出院病历,对抗菌药物使用率、品种选择合理率、术前给药时间和术后停药时间等进行统计分析。结果：干预后各项指标均较干预前有明显改善。抗菌药物使用率由干预前的71.30%降至干预后的34.86%,品种选择合理率由干预前的77.14%升至干预后的89.76%,术前0.5~2.0 h给药率由干预前的83.38%升至干预后的96.59%,术后24 h停药率由干预前的31.95%升至干预后的54.63%,术后48 h停药率由干预前的61.82%升至干预后的84.88%。结论：经过专项整治和临床药师的积极干预,骨科Ⅰ类切口手术预防性应用抗菌药物的各项指标都有明显改善,但仍未达到卫计委的要求,仍需坚持加强抗菌药物临床应用管理,巩固干预成果,进一步提高合理用药水平。

OBJECTIVE： To investigate the changes of preventive application of antibiotics in type Ⅰ incision in department of orthopedics before and after intervention,so as to provide reference for further standardization in application of antibiotics. METHODS： Retrospective statistical methods were adopted,the discharge medical records of typeⅠincision in department of orthopedics in Dongguan Donghua Hospital from 1st to 15 th monthly in 2011（ beforeintervention） and 2013（ after intervention） were extracted to conduct the statistical analysis in terms of application rate of antibiotics,rational rate of categories selection,preoperative administration time and postoperative withdrawal time,etc.. RESULTS： Compared with before intervention,various indicators after intervention were improved significantly.The application rate of antibiotics decreased from 71. 30% before intervention to 34. 86% after intervention; the rational rate of categories selection increased from 77. 14% to 89. 76%; the administration rate of preoperative 0. 5-2. 0 h increased from 83. 38% to 96. 59%; and the withdrawal rate of postoperative 24 h increased from 31. 95% to 54. 63%,the withdrawal rate of postoperative 48 h increased from 61. 82% to 84. 88%. CONCLUSIONS： After the special rectification and intervention of clinical pharmacists,various indicators of preventive application of antibiotics in typeⅠincision in department of orthopedics had been improved significantly,which still do not reach the standard formulated by National Health and Family Planning Commission. Therefore,it is necessary to strengthen the management of clinical application of antibiotics,consolidate the intervention outcome,and further improve the level of rational drug use.