综合干预对部分Ⅰ类切口手术围术期预防性应用抗菌药物合理性的影响

Effects of Comprehensive Intervention on the Rationality of Prophylactic Application of Antibiotics in Perioperative Period of Partial Type Ⅰ Incisions

目的:探索综合干预措施对苏州大学附属第三医院(以下简称"该院")部分Ⅰ类切口手术围术期预防性应用抗菌药物合理性的影响,促进合理用药。方法:该院自2015年10月起对抗菌药物的临床应用实施了制订围术期抗菌药物合理应用规范、加强医务人员抗菌药物合理应用培训、临床药师指导合理用药及完善奖惩机制等综合干预措施。利用医院病历管理系统,随机抽取综合干预前(2015年3—10月)、综合干预后(2017年3—10月)3种典型Ⅰ类切口手术甲状腺手术、乳腺手术及疝气手术病历各80份,比较综合干预前后上述手术围术期预防性应用抗菌药物的适应证、品种选择、给药时机、用药疗程、剂量及联合用药等的合理率和抗菌药物预防性使用率,考察综合干预实施效果。结果:综合干预后,甲状腺手术、乳腺手术及疝气手术等3种Ⅰ类切口手术围术期抗菌药物预防性使用率由综合干预前的26.25%降至3.75%,预防性给药时间合理率由31.75%升至100%,平均用药疗程由2.5 d缩短至1.0 d,品种选择合理率亦有提高。结论:综合干预措施可以有效提高Ⅰ类切口手术围术期预防性应用抗菌药物的合理性,但仍需不断优化完善,强化干预力度,进一步提高合理用药水平。

OBJECTIVE： To probe into the effects of comprehensive intervention on the rationality of prophylactic application of antibiotics in perioperative period of partial type Ⅰ incisions in the Third Affiliated Hospital of Soochow University（ hereinafter referred to as ＂this hospital ＂）,so as to promote rational drug application. METHODS：Comprehensive intervention measures of formulating application guidelines for perioperative antibiotics,strengthening the rational application training of antibiotics for medical staff,guiding clinical pharmacists for rational application of drugs,improving reward and punishment mechanisms were conducted since Oct. 2015 in this hospital. Using the hospital medical record management system,80 records of thyroid surgery,breast surgery and hernia surgery of before comprehensive intervention（ Mar. to Oct. 2015） and after comprehensive intervention（ Mar. to Oct. 2017） were retrieved and compared in terms of indication,selection of drug,timing of drug administration,course of treatment,reasonable rates of dosage and drug combination,and prophylactic application rates of antibiotics,so as to investigate the effects of comprehensive intervention. RESULTS： After the comprehensive intervention, the prophylactic application rates of antibiotics in thyroid surgery,breast surgery and hernia surgery had decreased from 26. 25% to3. 75%,the rational rate of administration time had increased from 31. 75% to 100%,the average treatment course had shortened from 2. 5 days to 1. 0 day,with also increasing rational rate of drug selection. CONCLUSIONS：Comprehensive intervention can effectively improve the rationality of prophylactic application of antibiotics in perioperative period of type Ⅰ incisions,however,continuous optimizing of comprehensive intervention should be reinforced,so as to further promote rational drug application.