加权TOPSIS法评价肝胆及胰腺手术预防性使用抗菌药物的合理性

Evaluation of the rationality of prophylactic use of antimicrobial drugs in hepatobiliary and pancreatic surgery by the weighted TOPSIS method

目的:采用层次分析(AHP)法和逼近理想解排序(TOPSIS)法评价肝胆及胰腺手术围术期预防性抗菌药物使用的合理性,为肝胆外科预防性抗菌药物的使用管理提供参考。方法:以《抗菌药物临床应用指导原则(2015年版)》、抗菌药物超说明书用法专家共识、相关抗菌药物药品说明书为依据,建立肝胆及胰腺手术预防性抗菌药物使用标准,采用AHP法对指标进行赋权并结合TOPSIS法对淮北市人民医院2022年1月—2022年3月病历资料中肝胆及胰腺手术预防性抗菌药物的应用情况进行合理性评价。结果:建立的预防性抗菌药物使用标准权重较高的前3个指标分别为术前用药时机(权重为0.283 2)、品种选择(权重为0.204 3)和给药剂量(权重为0.1439)。共纳入145份病历,其中评价为合理用药的72例,占比49.7%;基本合理用药的10例,占比6.9%;不合理用药的63例,占比43.4%;结论:AHP加权的TOPSIS法可用于预防性抗菌药物的合理性评价,能够发现使用过程中存在的问题,为临床科室加强管理和药学部门实施干预提供依据,促进预防性抗菌药物的合理使用。

OBJECTIVE Analytical hierarchy process(AHP) and Technique for order preference by similarity to an ideal solution(TOPSIS) were used to evaluate the rationality of perioperative prophylactic antimicrobial drug use in hepatobiliary and pancreatic surgery, providing a reference for the management of prophylactic antimicrobial drug use in hepatobiliary surgery.METHODS Based on the Guidelines for Clinical Use of Antimicrobial Drugs(2015 edition),the Expert Consensus on the Use of Antimicrobial Drugs in Excess of Instructions and the relevant antimicrobial drug instructions, the criteria for the use of preventive antimicrobial drugs in hepatobiliary and pancreatic surgery were established, and the indicators were weighted using the hierarchical analysis method(AHP) and combined with the TOPSIS method to evaluate the rationality of the use of preventive antimicrobial drugs in hepatobiliary and pancreatic surgery in the medical records of our hospital from January 2022 to March 2022.RESULTS The top three indicators with higher weighting for the established criteria for the use of preventive antimicrobial drugs were the timing of preoperative drug administration(weighting 0.283 2),species selection(weighting 0.204 3) and dose of drug administration(weighting 0.143 9).A total of 145 medical records were included, of which 72 cases(49.7%) were evaluated as reasonable medication use, 10 cases(6.9%) were basically reasonable medication use, and 63 cases(43.4%) were unreasonable medication use.CONCLUSIONS The AHP-weighted TOPSIS method can be used to evaluate the rationality of prophylactic antimicrobial drugs, which can identify problems in the use process and provide a basis for clinical departments to strengthen management and pharmacy departments to implement interventions to promote the rational use of prophylactic antimicrobial drugs.