药学干预前后骨科Ⅰ类切口手术围术期抗菌药物预防性应用分析

Analysis on Prophylactic Application of Antibiotics During Perioperative Period in Orthopedic Type Ⅰ Incision Before and After Pharmaceutical Intervention

目的:评价药学干预措施对提高东莞市中医院(以下简称"我院")骨科Ⅰ类切口手术围术期合理预防性应用抗菌药物水平的可行性和有效性。方法:随机选取我院骨科Ⅰ类切口手术患者,其中2015年7月(干预前)625例,2017年7月(干预后)668例,对干预前后围术期抗菌药物预防性应用情况进行统计分析。结果:干预后,我院骨科Ⅰ类切口手术围术期抗菌药物预防性使用率由干预前的59.8%(374/625)降至49.3%(329/668),降幅>10%;预防性用药疗程≤24 h者所占病例由干预前的76.7%(287/374)升至86.3%(284/329),升幅约10%;预防性给药时间合理率由干预前的91.7%(343/374)升至96.7%(318/329),升幅为5%;预防性用药品种选择合理率由干预前的89.0%(333/374)升至94.2%(310/329),升幅>5%。干预前后手术部位感染发生率的差异无统计学意义(P>0.05)。结论:我院所采取的药学干预措施对提高骨科Ⅰ类切口手术围术期预防性应用抗菌药物的管理水平和合理用药水平有促进作用,但仍需对围术期抗菌药物预防性使用率等指标进行跟踪管理和干预,实现持续改进。

OBJECTIVE： To evaluate feasibility and effectiveness of pharmaceutical intervention in improving rational prophylactic application of antibiotics during perioperative period in orthopedic type Ⅰ incision in Dongguan Hospital of Traditional Chinese Medicine（ hereinafter referred to as ＂our hospital＂）. METHODS： Patients underwent orthopedic type Ⅰ incision in our hospital were randomly selected,of 625 cases in Jul. 2015（ before intervention）and 668 cases in Jul. 2017（ after intervention）,prophylactic application of antibiotics during perioperative period before and after intervention were analyzed. RESULTS： After intervention, the prophylactic application rate of antibiotics during perioperative period in orthopedic type Ⅰ incision in our hospital had decreased from 59. 8%（ 374/625） of before intervention to 49. 3%（ 329/668）,with decreasing amplitude of 〉10%; the percentage of cases with prophylactic treatment course of ≤24 h had risen from 76. 7%（ 287/374） of before intervention to 86. 3%（ 284/329）,with increasing amplitude of about 10%; the rationality rate of prophylactic medication time had risen from91. 7%（ 343/374） of before intervention to 96. 7%（ 318/329）,with increasing amplitude of 5%; the rationality rate of drug selection for prophylactic application had risen from 89. 0%（ 333/374） of before intervention to 94. 2%（ 310/329）,with increasing amplitude of 〉5%. There was no statistical significance in the difference of incidences of surgical infection before and after intervention（ P〉0. 05）. CONCLUSIONS： The pharmaceutical intervention in our hospital has improved the management and rationality of prophylactic application of antibiotics during perioperative period in orthopedic type Ⅰ incision,while further track supervision and intervention on the prophylactic application rate of antibiotics during perioperative period are still needed to realize continuous improvement.