临床药师对急性化脓性阑尾炎患者围手术期抗菌药物应用的干预及效果分析

Intervention and Effect Analysis of Antibiotics Used by Clinical Pharmacist in Patients with Acute Suppurative Appendicitis during Perioperative Period

目的评价临床药师干预急性化脓性阑尾炎患者围手术期抗菌药物应用的效果。方法回顾性分析2015年6月至2016年5月实施干预前的急性化脓性阑尾炎手术病历127例(非干预组),总结其抗菌药物应用中存在的主要问题并提出干预措施,另选取2016年6月至2017年5月急性化脓性阑尾炎手术病历100例(干预组)进行对比分析,比较两组抗菌药物用药选择、给药剂量频次、给药疗程、给药时机、联合用药、更换药物、药物费用、切口感染率等情况,评价围手术期抗菌药物应用的合理性及干预效果。结果经临床药师干预,急性化脓性阑尾炎围手术期抗菌药物给药时机合理比例由29.13%升至84.00%(p<0.05),联合用药合理比例由76.38%升至100%(p<0.05),药物金额由平均779.13元降至387.87元(p<0.05),给药疗程由平均5.43天缩短至3.28天(p<0.05),干预前后给药剂量频次、切口感染率的差异具有统计学意义(p<0.05)。结论临床药师对急性化脓性阑尾炎围手术期应用抗菌药物的干预是有效、可行的,能显著提高围手术期抗菌药物应用的合理性。

Objective To evaluate the effect of clinical pharmacist intervention on the application of antibiotics during perioperative period in patients with acute suppurative appendicitis.Methods We retrospectively reviewed 127 cases（non-intervention group） of patients with acute suppurative appendicitis before intervention from June 2015 to May 2016.We summarized the main problems in the application of antibiotics and put forward the intervention measures.We then selected 100 cases of acute suppurative appendicitis from June 2016 to May 2017（intervention group）.We compared and analyzed the differences between the two groups,including drug choice,dose and frequency,drug session,timing,combined usage of drug,drug replacement,medication costs,incision infection rate,etc.We also evaluated of the rationality and intervention effect of the use of antibiotics in perioperative period.Results Through clinical pharmacist intervention,the proportion of patients who received timely medication among those with acute suppurative appendicitis during perioperative period was increased from 29.13% to 84.00%（P〈0.05）,the proportion of reasonable combined usage of drug increased from 76.38% to 100%（P〈0.05）.The mean cost of medication decreased from 779.13 to 387.87 yuan（P〈0.05）.The mean duration of medication decreased from 5.43 days to 3.28 days（P〈0.05）.In addition,the differences of drug dose and frequency,and incision infection rate were statistically significant（P〈0.05）.Conclusion The antibiotics used by clinical pharmacist in patients with acute suppurative appendicitis during perioperative period is effective and feasible,and can significantly improve the rationality of antibiotic application in perioperative period.