神经外科抗菌药物应用合理性提升方案研究

Research on the Rationality Improve of the Application of Antibiotics in Neurosurgery De⁃partment

目的:通过分析神经外科(含脑科ICU)预防及治疗性使用抗菌药物的现状,评价其使用合理性,科学制定措施,为安全、有效、经济用药提供依据。方法:评估452例神经外科使用抗菌药物患者的用药合理性,通过多学科协作,针对不合理问题分析原因,制定抗菌药物使用规范,加强用药宣教,以减少院内感染,保证患者健康。结果:制定并实施了《江阴市人民医院神经外科抗菌药物使用规范(试行)》,手术预防性使用抗菌药物合格率从64.29%升高至94.12%;时间超过3 h的手术,术中追加抗菌药物的比例显著增加;丙戊酸钠与碳青酶烯类抗菌药物联合应用比例下降,且丙戊酸钠使用率有所减少;高龄患者头孢噻利使用率较前稍有下降。结论:《江阴市人民医院神经外科抗菌药物使用规范(试行)》方便、快捷、实用,增加了手术预防用药、药物相互作用及抗菌药物使用人群的年龄相关性等方面的合理性。

Objective:To analyze the current situation of preventive and therapeutic use of antimicrobial drugs in neurosurgery(in⁃cluding the Neurosurgical intensive care unit),to evaluate its rationality,and to provide safety,effective and economical basis for drug use.Methods:We evaluated the rationality of antibacterial use in 452 neurosurgery cases.Multidisciplinary team was organized to ana⁃lyze the cause of unreasonable use,develop specifications for the use of antibacterial,propaganda and educate the reasonable safe med⁃ication to reduce hospital infection and ensure patient health.Results:We developed our own first drugspecification:Jiangyin People’s Hospital neurosurgery specification of antimicrobial agents.The pass rate of preventive use of antimicrobial drugs in surgery in⁃creased from 64.29%to 94.12%;The proportion of additional antimicrobial drugs in surgery which lasted more than 3 h increased sig⁃nificantly;The proportion of combined applications of sodium valproate and carbon-to-chlorite antimicrobialdrugs decreased,and the utilization rate of sodium valproate decreased;The utilization rate of cefoselis use in elderly patients decreased slightly.Conclusion:The specification is convenient,fast and practical.This project has increased the rationality of surgical prophylaxis,drug interactions,age correlation of antimicrobial drugs use.