小儿神经外科Ⅰ类切口手术预防用抗菌药物的优化

Optimization of Preventive Use of Antibiotics in Type Ⅰ Incision Operation of Pediatric Neurosurgery by Clinical Medication Pathway

目的探讨利用临床用药路径对小儿神经外科Ⅰ类切口手术围手术期抗菌药物预防使用进行合理性干预,为小儿神经外科合理使用抗菌药物提供参考。方法建立神经外科Ⅰ类切口手术预防使用抗菌药物临床用药路径,调取小儿神经外科2016年1月—2019年12月Ⅰ类切口手术患儿出院病历1484份,对围手术期抗菌药物选择、给药时间、用法用量和疗程按照年份进行回顾性分析。结果小儿神经外科抗菌药物预防使用率干预前(2016年)为23.85%,干预后(2017年、2018年、2019年)分别为20.28%,17.86%,17.28%,均低于30%;药物品种合理率干预前60.26%,干预后(2017年、2018年、2019年)分别为97.26%,98.57%,100.00%;用药时机合理率干预前93.59%,干预后(2017年、2018年、2019年)分别为97.26%,100.00%,100.00%;用药疗程合理率干预前为26.92%,干预后(2017年、2018年、2019年)分别为76.71%,82.86%,84.29%。结论临床用药路径的实施有效提高了小儿神经外科围手术期预防使用抗菌药物合理率。

Objective To explore the rational intervention of the use of antibiotics in the perioperative period of pediatric neurosurgery type Ⅰ incision operation by clinical medication pathway to provide a reference for the rational use of antibiotics in pediatric neurosurgery. Methods The clinical medication pathway of prophylactic use of antibiotics in type Ⅰ incision surgery of neurosurgery has been established. A total of 1484 cases of pediatric neurosurgery from January 2016 to December 2019 with type Ⅰ incision surgery were enrolled,and the perioperative antimicrobial selection,administration time,usage and dosage,and course of treatment were retrospectively analyzed according to the years. Results From 2016 to 2019,the prophylactic use rate of antibiotics in pediatric neurosurgery decreased from 23.85% before intervention to 20.28%,17.86%and 17.28%,all lower than 30%. The rational rate of drug varieties increased from 60.26% to 97.26%,98.57% and 100.00%,respectively. The rational rate of medication timing increased from 93. 59% before intervention to 97. 26%,100. 00% and100.00%,respectively. The rational rate of treatment course increased from 26.92% to 76. 71%,82. 86% and 84. 29%,respectively. Conclusion Implementing a clinical medication pathway can effectively improve the rational rate of prophylactic use of antibiotics in pediatric neurosurgery during perioperative period.