小儿腹股沟疝修补术围手术期预防用药干预管理与效果评价

Evaluation on the intervention effect of prophylactic antibiotics in children with inguinal hernia during perioperative period

目的:评价小儿腹股沟疝修补术围手术期预防用药的干预管理效果,探索适合小儿腹外疝修补术预防用药的干预模式。方法:选取2011年手术病例作为非干预组,回顾性分析围手术期预防用药存在的主要问题,将2012-2015年手术病例作为干预组,对围手术期抗菌药物预防使用率、平均预防用药天数、平均预防用药费用、平均住院天数、手术部位感染率等指标进行重点监控和干预管理。结果:经过4年干预管理,小儿腹股沟疝修补术围手术期抗菌药物预防使用率由干预前的100%下降为干预后的0%;平均预防用药天数由干预前的≤1 d下降为干预后的0d;平均预防用药费用由干预前的37.66元下降为干预后的0元;平均住院天数均≤1 d;干预前后手术部位感染率无显著性差异(P>0.05)。结论:小儿腹股沟疝修补术围手术期预防用药干预措施具有可行性和有效性,对安全、有效、经济、合理地使用抗菌药物起到了积极的促进作用,为医院设计单病种临床路径和降低单病种费用提供了参考依据,也为进一步规范其它清洁手术预防用药提供了可操作性的干预模式。

OBJECTIVE To explore the suitable intervention mode of perioperative prophylactic antibiotics in children with inguinal hernia by evaluating the intervention effect of perioperative prophylactic antibiotics.METHODS Clinical data were retrospectively analyzed to study the main problem in prophylactic antibiotics for children with inguinal hernia treated in 2011（non-intervention group）,and to monitor the ratio of prophylactic antibiotics for those treated from2012 to 2015（intervention group）,by critically monitoring and intervening average medication days,mean medication costs,average length of hospital stay and surgical site infection.RESULTS With four years of intervention,the ratio of perioperative prophylactic antibiotics was reduced from100%to 0.00%,the average medication days from ≤1 day to 0day,the mean medication costs from36.77 yuan to 0yuan.Average length of hospital stay was≤1 day in both groups.No significant difference was found in comparison of the incisional infection ratio between intervention group and non-intervention group（P〈0.05）.CONCLUSION The intervention measure is effective and feasible,since it can promote safe use of antibiotics effectively,economically and rationally,and it can provide evidence for designing clinical pathway of single disease to reduce the costs,and provide operable intervention mode for administrating antibiotics prophylactically in other clean surgeries.