手足显微外科断指(趾)再植手术围术期抗菌药物使用的合理性调查

Rationality of Perioperative Use of Antibiotics in Replantation of Severed Fingers(Toes)in Hand and Foot Microsurgery

目的:对本院手足显微外科断指(趾)再植手术围术期应用抗菌药物的情况进行调查及用药合理性分析,为规范使用抗菌药物提供依据。方法:对2019年1~12月本院手足显微外科施行断指(趾)再植手术患者在围术期应用抗菌药物的情况进行整理、统计和分析。考察患者抗菌药物使用的总体情况及抗菌药物的不合理使用情况。结果:①抗菌药物的总体情况:合计466例断指(趾)再植手术病例,在围术期使用抗菌药物者,占100%(466/466)。使用频率最高的是头孢菌素类,占82.40%(384/466);其次是林可霉素类,占10.73%(50/466)。术前预防使用抗菌药物,占56.87%(265/466);术后抗菌药物的使用,占39.70%(185/466)。抗菌药物单药使用,占73.82%(344/466);两药联用,占25.54%(119/466)。②抗菌药物不合理使用情况:合计150例出现不合理用药,占32.19%(150/466)。主要为术后用药时间过长,占14.59%(68/466),包括头孢孟多酯钠、林可霉素、奥硝唑;其次为使用了非头孢菌素类抗菌药物17.60%(82/466),包括林可霉素类(50例)、硝基咪唑类(32例)。结论:手足显微外科应加强对断指(趾)再植手术围术期规范使用抗菌药物的用药管理,提高抗菌药物的合理使用率。

Objective:To investigate the perioperative application of antibiotics in finger(toe)replantation in hand and foot microsurgery in a hospital and analyze the rationality of the use of antibiotics,so as to provide a basis for the standardized use of antibiotics.Methods:From January to December 2019,the use of antibiotics in the perioperative period of patients undergoing finger(toe)replantation in our hospital was analyzed to investigate the overall use of antibiotics and the unreasonable use of antibiotics.Results:①The overall situation of antibiotics application:of a total of 466 cases of replantation of severed fingers(toes),the use of antibiotics during perioperative period was 100%(466/466).Cephalosporins is the most frequently used antibiotics,accounted for 82.40%(384/466),followed by Lincomycin accounted for 10.73%(50/466).The prophylactic use of antibiotics before operation accounted for 56.87%(265/466),and the use of antibiotics after operation accounted for 39.70%(185/466).The use of single antibiotic accounted for 73.82%(344/466),and use of two drugs combination accounted for 25.54%(119/466).②Unreasonable use of antibiotics:There were 150 cases of irrational drug use(accounting for 32.19%,150/466),which included prolonged drug use time after surgery(68/466,14.59%),involving cefmendoxil sodium,lincomycin and ornidazole.Irrational use of non-cephalosporin antibiotics accounted for 17.60%(82/466),including lincomycin(50 cases),nitroimidazole(32 cases).Conclusion:In hand and foot microsurgery,it is necessary to strengthen the management of the use of antibiotics during the perioperative period of replantation of severed fingers(toes)and improve the rational use rate of antibiotics.