主动脉腔内隔绝术抗菌药物预防应用干预研究

Study on intervention in the prophylactic antibacterial agents in endovascular aortic repair

目的:探讨药学干预对主动脉腔内隔绝术围手术期抗菌药物预防应用的影响效果。方法:回顾性从某院血管外科行主动脉腔内隔绝术患者出院病历中,抽取2015年的107份病例作为干预前组,另抽取2017年1月-2018年5月的108例为干预后组,分析比较药学干预前后主动脉腔内隔绝术患者抗菌药物预防性使用率、品种选择、围手术期用药疗程及术后体温、血常规情况等。结果:经过药学干预后,主动脉腔内隔绝术患者抗菌药物预防性应用率由100%下降至90.74%,抗菌药物的品种选择、合理率及用药疗程合理率较干预前明显提高,干预后组术后发热患者数及平均体温低于干预前组,整个住院期间抗菌药物使用的DDDs亦明显下降,以上差异均有统计学意义(P<0.05),术后两组患者血象升高的人数无明显差异(P>0.05)。结论:药学干预有利于提高我院血管外科行主动脉腔内隔绝术患者抗菌药物预防应用的合理性,但仍然存在预防使用率过高、用药疗程过长等问题,临床药师应继续深入临床进行跟踪和干预,协助医生制订用药方案,促进临床合理用药。

OBJECTIVE To discuss the impact effect on pharmaceutical intervention in the prophylactic antibacterial agents in endovascular aortic repair.METHODS The medical records of patients who underwent endovascular aortic exclusion in the Department of Vascular Surgery of our hospital were retrospectively analyzed.107 cases in 2015 were selected as the pre-intervention group,and another 108 cases in the post-intervention group from January 2017 to May 2018 were selected.The preventive use rate of antibacterial drugs,variety selection,perioperative medication course,postoperative body temperature and blood routine were analyzed and compared before and after pharmaceutical intervention.RESULTS After pharmaceutical intervention,the prophylactic antibacterial agents rate of the patients with endovascular aortic repair has fallen from 100%to 90.74%.The reasonable rate of rational course of treatment for the selection of antibacterial drugs was significantly higher than that before intervention.The number of patients with postoperative fever and mean body temperature in the intervention group were lower than those in the intervention group.The DDDs of antibacterial drugs used during the whole hospital stay were also significantly decreased.The above differences were statistically significant(P<0.05).There was no significant difference in the number of patients with elevated hemogram between the two groups after operation(P>0.05).CNCLUSION Pharmaceutical intervention is beneficial to improve the rationality of prophylactic use of antibacterial drugs in patients undergoing endovascular aortic exclusion in the Department of Vascular Surgery of our hospital,but there are still problems such as prevention use rate and long course of treatment.Clinical pharmacists should continue to go deep into clinical practice for follow-up and intervention to assist doctors in formulating medication plans and promote the rational use of drugs in clinical practice.