骨科患者围术期应用抗菌药物对预防感染及炎症因子水平的影响

Effect of perioperative use of antibiotics on prevention of infections and inflammatory factor levels of orthopedics department patients

目的探讨骨科患者围术期应用抗菌药物对预防感染及炎症因子水平的影响。方法选取2014年1月-2015年12月医院骨科接受手术治疗的586例患者作为临床研究对象,采用随机数字表法将患者随机分为干预组294例和对照组292例,对照组患者围术期常规应用抗菌药物,干预组患者围术期干预性应用抗菌药物,比较两组患者感染率及炎症因子水平变化情况。结果对照组患者术前0.5~2h给药率为93.49%,药物不良反应发生率3.42%,手术切口感染率1.37%,干预组患者分别为97.62%、1.02%、0,两组比较差异有统计学意义(P<0.05);对照组患者抗菌药物费用(1284.30±51.02)元,药费(2986.74±110.31)元,住院费用(9955.76±271.49)元,住院时间(12.65±2.08)d,干预组分别为(256.93±22.47)元、(2135.73±86.50)元、(8141.89±246.35)元、(8.92±1.54)d,两组比较差异有统计学意义(P<0.05);对照组患者选择药物不合理率3.08%,联合用药不合理率2.40%,预防用药时机不合理率6.50%,术后用药时间过长发生率4.11%,干预组患者分别为0.68%、0.34%、2.38%、1.36%,两组比较差异有统计学意义(P<0.05);对照组患者炎症因子TNF-α(68.62±8.16)pg/mL,IL-6(225.45±15.50)pg/mL,IL-8(398.75±36.21)pg/mL,CRP(12.81±2.03)mg/L;干预组患者分别为(40.65±6.02)pg/mL、(169.23±12.13)pg/mL、(329.87±32.24)pg/mL、(9.23±1.75)mg/L,两组比较差异有统计学意义(P<0.05)。结论骨科患者围术期干预性应用抗菌药物对于预防手术感染,调节炎症因子,降低医疗费用,提高手术效果均具有十分重要的临床意义。

OBJECTIVE To explore the effect of perioperative use of antibiotics on prevention of infections and inflammatory factor levels of orthopedics department patients.METHODS A total of 586 patients who received surgical procedures in department of orthopedics from Jan 2014 to Dec 2015 were recruited as the study objects and randomly divided into the intervention group with 294 cases and the control group with 292 cases.The control group was treated with conventional use of antibiotics during perioperative period,while the intervention group was given interventional use of antibiotics during perioperative period.The incidence of infections and levels of inflammatory factors were observed and compared between the two groups of patients.RESULTS The administration rate was93.49%in the control group at 0.5-2hours before the surgery,97.62%in the intervention group;the incidence of drug-induced adverse reactions was 3.42%in the control group,1.02%in the intervention group;the incidence of surgical incision infection was 1.37% in the control group,0in the intervention group;there was significant difference between the two groups（P〈0.05）.The cost of antibiotics was（1284.30±51.02）yuan in the control group,（256.93±22.47）yuan in the intervention group;the cost of medicine was（2986.74±110.31）yuan in the control group,（2135.73±86.50）yuan in the intervention group;the hospitalization cost was（9955.76±271.49）yuan in the control group,（8141.89±246.35）yuan in the intervention group;the length of hospital stay was（12.65 ± 2.08）days in the control group,（8.92 ± 1.54）days in the intervention group;there was significant difference between the two groups（P〈0.05）.The rate of unreasonable use of antibiotics was 3.08%in the control group,0.68%in the intervention group;the rate of unreasonable combination use of antibiotics was2.40%in the control group,0.34% in the intervention group;the rate of unreasonable timing of antibiotics prophylaxis was 6.50%in the control group,2.38%in the intervention group;the incidence of over long postoperative medication was 4.11%in the control group,1.36%in the intervention group;there was significant difference between the two groups（P〈0.05）.The TNF-αlevel was（68.62±8.16）pg/mL in the control group,（40.65±6.02）pg/mL in the intervention group;the IL-6level was（225.45±15.50）pg/mL in the control group,（169.23±12.13）pg/mL in the intervention group;the IL-8level was（398.75±36.21）pg/mL in the control group,（329.87±32.24）pg/mL in the intervention group;the CRP level was（12.81±2.03）mg/L in the control group,（9.23±1.75）mg/L in the intervention group;there was significant difference between the two groups（P〈0.05）.CONCLUSIONThe perioperative interventional use of antibiotics has great clinical significance in prevention of surgical incision infections in patients of orthopedics department,regulation of inflammatory factors,reduction of medical costs,and improvement of surgical effect.