清洁手术切口围术期抗菌药物预防应用的干预研究

Effect of intervention on prophylactic use of antibiotics in clean surgical incisions during perioperative period

目的：评价经医院一次和二次干预措施后清洁手术切口围术期抗菌药物预防应用的合理性。方法分别收集杭州市萧山区第三人民医院2010年4至11月、2013年4至11月、2014年4至11月所有清洁手术患者出院病历，其中276例患者纳入干预前组、439例患者纳入一次干预组、443例患者纳入二次干预组。对3组患者围术期抗菌药物预防使用率、用药时间和疗程，及预防使用抗菌药物的种类进行回顾性分析。采用 Kruskal-Wallis 和χ^2检验分析数据。结果干预前组、一次干预组和二次干预组抗菌药物使用率分别为97．10％（268/276）、31．44％（138/439）和11．74％（52/443），预防用药率差异具有统计学意义（χ^2＝537．78，P 〈0．01）；三组预防用药的合理率分别为10．45％（28/268）、36．23％（50/138）和86．54％（45/52），差异亦具有统计学意义（χ^2＝137．20， P 〈0．01）。用药疗程由干预前的6（3-7）d 缩短到干预措施后的1（1-2）d 和1（1-2）d，差异具有统计学意义（χ^2＝214．77，P 〈0．01），且术前0．5-2 h 预防用药患者比例上升，差异具有统计学意义（χ^2＝85．976，P 〈0．01）。一、二代头孢菌素使用率从干预前的37．31％（100/268）上升为二次干预后的88．64％（46/52）。结论采取干预措施后，清洁手术切口围术期抗菌药物预防使用率降低、合理率上升，且术后切口均未发生感染。

Objective To evaluate the effect of intervention on prophylactic antibiotic use in clean operations during perioperative period.Methods Clinical data from discharged patients with clean surgical incisions were collected from the Xiaoshan Third People’s Hospital,including 276 admitted from April to November 201 0 （pre-intervention group）,439 admitted from April to November 201 3 （first intervention group）and 443 patients admitted from April to November 201 4 （second intervention group ）.The utilization,medication time,course of drugs treatment and types of antibacterial drugs during perioperative period were retrospectively analyzed among three groups.Kruskal-Wallis test and χ^2 test were used to analyze data.Results Prophylactic antibacterial utilization rate was 97.1 0%（268 /276）before intervention,which dropped to 31 .44%（1 38 /439）and 1 1 .74%（52 /443）after first and second intervention,while the rates of＆amp;nbsp;rational drug use increased from 1 0.45%（28 /268）to 36.23% （50 /1 38）and 86.54%（45 /52）（χ^2 =537.78 and 1 37.20,P 〈0.01 ）.The course of antimicrobial drug treatment was 6 （3 -7 ）d before intervention,which was shortened to 1 （1 -2）d and 1 （1 -2）d after the first and second intervention （χ^2 =21 4.77,P 〈0.01 ）,respectively,the proportion of patients with perioperative prophylactic use of antimicrobial agents 0.5 -2 h before operation increased（χ^2 =85.976,P 〈0.01 ）.The use of first-and second-generation cephalosporins increased from 37.31 % （1 00 /268）to 88.64% （46 /52）after second intervention.Conclusion After interventions,the prophylactic use of antimicrobial drugs in clean surgical incisions during perioperative period is reduced,accompanied by increase in rational drug utilization.