骨科清洁切口预防性抗菌药物使用情况调查

目的统计骨科清洁切口围术期预防应用抗菌药物的情况，分析其合理性，为后续改进提供依据。方法回顾性分析2016年1月至12YI3092份清洁手术患者的出院病历，对其中1223份骨科病例围术期抗菌药物使用情况进行统计分析。结果1223例骨科患者中有564例预防性使用抗菌药物，使用率46．12％，其中骨折切开复位内固定术比例占45．79％，预防性使用抗菌药物比例为93．2l％；所有预防性使用抗菌药物均为单一用药，其中使用第一、二代头孢菌素542例次，占96．10％，三代头孢菌素的9例次，占1．60％。术前0．5～1h首次用药占70．74％，术后24h内停药198例，占35．11％，术后〉24h但在48h内停止用药的占52．30％。结论骨科清洁切口围手术期用药基本合理，但在术前给药时机把握、用药疗程上存在不合理现象，在围手术期抗菌药物的规范化使用有待进一步提高。

Objective To analyze the general situation of antimicrobial prophylaxis in orthopedics in a county hospital, and to propose some reasonable advice. Methods A total of 3092 cases of clean incision surgery were retrospective analyzed that including 1223 of which in orthopedics of a county hospital of Zhejiang Province from January 1st. to December 31th in 2016. Results 564 cases of total 1223 cases in orthopedics prescribe preoperative antibiotics, with a rate of 46.12%, 560 cases received fracture open reduction and internal fixation accounted, of which 93.21%; prophylactic used antibiotics. Only single drag was used for each case, and the antibiotics mainly consist of first or second generation cephalosporin （ 542 cases, accounting for 96.10% ） , three generation of cephalosporin in 9 cases. The first dosage used between 0.5 to 1 hour before operation accounted for 70.74%, 198 cases were discontinued before 24 hours, accounted for 35.11%, 52.30% of patients discontinued the antinlicrobial agents more than 24 hours but within 48 hours. Conclusions Anfimicrobial prophylaxis in clean incision in the hospital is generally reasonable. However, the timing of the medication and the course of medication are not reasonable before the operation, and the standardized use of antibiotics in the perioperative period should be further improved.