普外科I类手术围手术期抗菌药物应用与效果

Application and effect of perioperative antibiotics in type I general surgery

目的观察和研究普外科I类手术围手术期抗菌药物应用情况和应用效果,以期合理规范化用药。方法选取2014年5月~2016年9月228例普外科I类手术患者为观察组,2012年2月~2014年4月284例普外科I类手术患者为对照组。观察组采用回顾性监测方法、对照组采用前瞻性监测方法,比较2组患者抗菌药物应用种类、合理应用情况及I类手术抗菌药物应用率、手术结局。结果观察组第一代头孢菌素类应用率高于对照组,差异有统计学意义（P〈0.05）,大环内酯类与对照组比较差异无统计学意义。第二、三代头孢菌素类、喹诺酮类、氨基糖苷类及硝基咪唑类应用率低于对照组,差异有统计学意义（P〈0.05）。且抗菌药物用药指征合理、选取正确、应用时间合理、联合用药合理、剂量合理、每天应用次数合理及溶媒体积合理均高于对照组,差异有统计学意义（P〈0.05）。腹外疝手术、甲状腺手术和乳腺手术,抗菌药物应用率低于对照组,差异有统计学意义（P〈0.05）,手术感染率2组均为0。观察组平均住院时间（8.50±1.20）d显著低于对照组（15.00±2.30）d,差异有统计学意义（P〈0.05）。结论普外科I类手术围手术期抗菌药物严格按照制度标准应用,有助于促进临床规范合理化用药,降低耐药菌产生。

Objective To observe and study the application and effect of antimicrobial agents in type I general surgery,in order to rationalize the use of drugs. Methods 228 patients with type I general surgery from May 2014 to September 2016 were selected as the observation group. The patients in the type I general surgery group from February 2012 to April 2014 were selected as the control group. The observation group were retrospectively monitored,and the control group were prospectively monitored. The application of antimicrobial agents in the two groups of patients,the rational application and the application rate of antimicrobial agents in type I general surgery and outcome were compared. Results The application rate of the first generation cephalosporins in the observation group was significantly higher than that in the control group（ P〈0. 05）. There was no significant difference in application rate of macrolides compared with the control group. The application rates of the second generation and third generation cephalosporins,quinolones,aminoglycosides and nitroimidazoles were lower than those of the control group（ P〈0. 05）. And the rational use of antimicrobial agents,reasonable choice of time,rational combination of drugs,reasonable dose,reasonable frequency of administration and reasonable volume of solvent were higher than those of the control group,the differences were statistically significant（ P〈0. 05）. The antibiotic application rates of abdominal hernia surgery,thyroid surgery and breast surgery were lower than those of the control group,the differences were statistically significant（ P〈0. 05）. There was no infective case in the two groups. And the average length of stay in the observation group was（ 8. 50 ± 1. 20） days,which was lower than（ 15. 00 ± 2. 30） days in the control group,the difference was statistically significant（ P〈0. 05）. Conclusion Accordance with the principles of antibiotics in type I general surgery,it could rationalize medication and reduce the drug resistance.