577例Ⅱ类切口围术期预防性应用抗菌药物的合理性分析

Rationlity analysis of prophylactic application of antibiotics in 577 cases of typeⅡincision surgery

目的通过对Ⅱ类切口手术患者抗菌药物预防应用情况的分析,以期引起临床对Ⅱ类切口手术预防用药合理性的关注。方法对2019年出院的577例Ⅱ类切口手术患者的围手术期预防性应用抗菌药物情况进行回顾性分析,对抗菌药物的品种选择、给药时机、用药疗程等指标进行分析与评价。结果577例Ⅱ类切口手术患者全部预防性应用抗菌药物,品种选择以头孢菌素类和硝基咪唑类抗菌药物为主,二联用药占比较高,主要见于剖宫产等妇产科手术;用药时机以术前0.5~1h和夹住脐带后为主,术前>1 h主要见于鼻内窥镜下多个鼻窦开窗术等耳鼻喉科手术;预防用药时长<48 h占比较高,其中腹腔镜下卵巢病损切除术等妇科手术用药时长相对较长,平均值超过4 d。结论Ⅱ类切口手术预防用药存在选择广谱抗生素进行预防用药、用药时程过长等不合理问题,需加强抗菌药物预防性应用的管理,提高用药合理性。

Objective To analyze the prophylactic application of antibiotics in patients with typeⅡincision surgery in Liaoning Provincial People’s Hospital,so as to arouse clinical attention to the rationality of prophylactic use of antibiotics in typeⅡincision surgery.Methods A retrospective analysis was made on the perioperative prophylactic application of antibiotics in 577 patients with typeⅡincision who were discharged from hospital in 2019.The evaluation and analysis were made on the selection of antibiotics,timing of antibiotics,and treatment course.Results All 577 patients with typeⅡincision surgery were treated with prophylactic antibiotics.Cephalosporins and Nitroimidazoles were the main antibiotics,and combination of two drugs accounted for a relatively high proportion,which was mainly used in obstetrics and gynecology surgery such as cesarean section.The timing of antibiotics was mainly 0.5—1 h before surgery and after cutting umbilical cord,and>1 h before surgery was mainly used in byear,nose and throat(ENT)surgery such as antrostomy of multiple sinuses under nasal endoscope.The duration of medication<48 h was higher than that of other,gynecological surgery such as ovariectomy under laparoscopic,which has a mean of more than 4 days.Conclusion There are some irrational problems in the prophylactic application of antibiotics in typeⅡincision surgery such as the selection of broad-spectrum antibiotics,the long time course of use of antibiotics,etc.it is necessary to strengthen the management of prophylactic use of antibiotics and improve the rationality of use of antibiotics.