基于属性层次模型的神经外科手术预防性应用抗菌药物合理性评价

Evaluation on rationality of preventive application of antibioticsin neurosurgery based on attribute hierarchical model

目的:建立神经外科手术预防性应用抗菌药物合理性评价标准,为该科室手术抗菌药物预防使用提供参考。方法:以《抗菌药物临床应用指导原则》(2015版)、药品说明书、相关指南和专家共识为依据,制定神经外科手术预防应用抗菌药物合理性评价标准。采用属性层次模型(attribute hierarchical model, AHM)对2020年7月至2021年6月亳州市人民医院神经外科134例手术患者的归档病例进行分析评价。结果:该科室手术预防应用抗菌药物主要不合理类型及扣分值为药物选择(1 056.36)、给药时机(637.73)、用药疗程(515.15)、给药剂量(397.58)。病例评分(medical record score, MRS)≥90的有26例(19.40%),85≤MRS<90的有8例(5.97%),80≤MRS<85的有26例(19.40%),MRS<80的有74例(55.22%)。结论:该院神经外科手术预防应用抗菌药物合理性较差,需加强管理,并采用综合干预提高神经外科手术预防应用抗菌药物的合理性。AHM法简便易行、客观实用、评价结果量化、结果真实可信,可用于围手术期抗菌药物预防使用合理性评价。

OBJECTIVE To establish the evaluation criteria for preventive application of antibiotics in neurosurgery, so as to provide a reference for the rational evaluation of preventive application of antibiotics in this department.METHODS Based on guiding principles for Clinical Application of Antibacterials(2015 edition),drug instructions, related guidelines and references, the rationality evaluation standard for the preventive application of antibiotics in neurosurgery was formulated.The archived cases of 134 neurosurgical patients in the hospital from July 2020 to June 2021 were analyzed and evaluated by attribute hierarchical model(AHM).RESULTS The main unreasonable types and scores of antibiotics for surgical prevention in this department were drug selection(1 056.36),timing of administration(637.73),course of administration(515.15)and dosage(397.58).There were 26 cases(19.40%)with Medical Record Score(MRS)≥90,8 cases(5.97%)with 85≤MRS<90,26 cases(19.40%)with 80≤MRS<85 and 74 cases(55.22%)with MRS<80.CONCLUSION The rationality of prophylactic use of antibiotics in neurosurgery in our hospital is poor, so it is necessary to strengthen management and adopt comprehensive intervention to improve the rationality of prophylactic use of antibiotics in neurosurgery.AHM is simple, objective and practical, the evaluation results are quantitative, and the results are true and reliable.It can be applied to the evaluation of the rationality of perioperative prophylactic use of antibiotics.