多学科合作模式下胃部及结直肠手术预防性应用抗菌药物的效果评价

Evaluation on effect of usage of perioperative antibacterial drugs prophylaxis in stomach and colorectal operations under multi-disciplinary treatment

目的评价在多学科合作模式下胃肠外科实施干预措施前后抗菌药物的预防使用情况,探讨多学科合作模式下干预性研究开展的可行性和有效性。方法选取胃肠外科在胃部及结直肠手术中实施干预措施前(非干预组,2015年10月至2016年3月)后(干预组,2016年4月至2016年9月)预防性应用抗菌药物的资料并进行回顾性研究,比较2组资料围术期抗菌药物的使用情况、住院费用和手术部位感染(SSI)发生率等指标。结果干预后胃部及结直肠手术抗菌药物品种选择合理率、初次给药时机合理率明显上升(P <0. 05),术后预防用药天数明显缩短(P <0. 05);干预前后SSI发生率差异无统计学意义(P> 0. 05);干预组抗菌药物费用较非干预组明显减少(P <0. 05)。结论多学科合作模式下开展的围术期抗菌药物应用的干预性研究是科学、可行的。通过合理干预胃肠外科围术期抗菌药物的应用,不仅提高了抗菌药物预防性应用的合理性,而且有效地降低了患者抗菌药物费用。

AIM To evaluate the effect by comparing the usage of perioperative antibacterial drugs prophy- laxis in intervention group and non-intervention group of stomach enterochirurgia, and investigate the feasibility and validity of prospective study under the multi-disciplinary treatment. METHODS Medical records of surgery pa- tients who had stomach and colorectal surgery were collected and studied comparatively before （non-intervention group, from October 2015 to March 2016） and after carrying out intervention measures（ intervention group, from A- pril 2016 to September 2016 ） retrospective review was conducted. The usage of perioperative antibacterial drugs prophylaxis, hospitalization expenses and the incidence of surgical site infections etc. were compared. RESULTS The irrationality of perioperative prophylactic application of antibacterial drugs in stomach and colorectal surgery was suppressed effectively. Reasonable rate of medication before operation was markedly improved （P 〈 0.05 ）and the medication times were shorted observably（ P 〈 0.05 ）. Compared to non-intervention group, the rate of wound in- fection between 2 groups had no significant difference （ P 〉 0.05 ） , but the costs of antibacterial drugs decreased significandy （P 〈 0.05 ）. CONCLUSION The prospective study on the usage of perioperative antibacterial drugs prophylaxis under the multi disciplinary treatment model were proved to be scientific and feasible by this study. With the reasonable intervention management of perioperative antibacterial drugs prophylaxis, the rates of wound in- fection in stomach and colorectum surgery do not increase, but antimicrobial drug costs and the use density in stom- ach enterochirurgia decrease significantly