临床药师参与胸外科围手术期预防用抗菌药物管理的实践

The practice of clinical pharmacists participating in the management of prophylactic antibiotics during the perioperative period of thoracic surgery

目的探讨临床药师参与胸外科围手术期预防用抗菌药物管理中发挥的作用,并对参与实践后的效果进行评价。方法回顾性分析四川省人民医院温江医院2019年8月(实践前)胸外科围手术期抗菌药物使用情况,查找总结存在的问题,分析原因,临床药师与医师共同制定改进措施与方法。临床药师采用医嘱审核、药学查房、用药培训等方法持续干预。对比2019年8月(实践前组)及12月(实践后组)胸外科围手术期预防用抗菌药物使用情况,评价实践效果。结果临床药师对围手术期患者医嘱审核1次/d、药学查房2次/周、用药培训1次/月。实践前纳入22例患者,实践后纳入26例患者。两组患者年龄、性别、体质量、手术时间、切口类别、抗菌药物预防使用率差异均无统计学意义(均P>0.05)。实践后组,术前给药时机适宜率为100.0%,高于实践前组的88.2%;术前预防给药品种遴选合理率为100.0%,显著高于实践前组的44.4%(χ^(2)=17.50,P<0.001);术后预防用药疗程为(1.82±0.59)d,显著短于实践前组的(7.54±3.25)d(t=11.97,P<0.001);抗菌药物费用为316.00(237.00,454.25)元,显著低于实践前组的1136.00(391.81,2184.65)元(Z=-2.78,P<0.05);住院患者抗菌药物使用强度(DDD)为2.67(2.00,3.42),显著低于实践前组的8.88(3.92,19.18)(Z=-3.26,P<0.05);两组术后肺部感染发生率及患者住院总时间差异均无统计学意义(均P>0.05)。结论临床药师参与胸外科围手术期预防用抗菌药物的管理实践能有效促进围术期抗菌药物合理应用,显著提高预防给药品种合理率、缩短预防用药疗程、减少抗菌药物费用、降低抗菌药物使用强度且不增加术后肺部感染风险、不增加住院总时间。

Objective To explore the role of clinical pharmacists participating in the management of prophylactic antibiotics during the perioperative period of thoracic surgery,and to evaluate the effects after participating in the practice.Methods The use of antimicrobials during the perioperative period of thoracic surgery in Wenjiang Hospital of Sichuan Provincial People's Hospital in August 2019(pre-practice)was retrospectively analyzed.The existing problems were summarized,and the possible causes of the existing problems were analyzed.The improvement measures were jointly developed by clinical pharmacists and physicians.Clinical pharmacists continued to manage the use of antimicrobials by means of medication order reviews,ward rounds for pharmacy service,and medication training.The use of prophylactic antibiotics during the perioperative period of thoracic surgery was compared between August 2019(pre-practice group)and December 2019(post-practice group)and the practical effect was evaluated.Results Clinical pharmacists reviewed perioperative patients'medication orders once a day,ward rounds for pharmacy service twice a week,and medication training once a month.Twenty-two patients were enrolled before practice,and 26 patients were enrolled after practice.There were no significant differences in age,sex,body weight,operative time,type of surgical incision,and preventive use of antibiotics between the two groups(all P>0.05).In the post-practice group,the appropriate time for preoperative administration was 100.0%,which was significantly higher than 88.2%in the pre-practice group.The reasonable rate of preoperative preventive drug selection was 100.0%,which was significantly higher than 44.4%in the pre-practice group(χ^(2)=17.50,P<0.001).In the post-practice group,the duration of preventive medication was(1.82±0.59)days,which was significantly shorter than(7.54±3.25)days in the pre-practice group(t=11.97,P<0.001).In the post-practice group,the cost of antibacterial drugs was 316.00(237.00,454.25)yuan,which was significantly lower than 1136.00(391.81,2184.65)yuan in the pre-practice group(Z=-2.78,P<0.05).The defined daily dose of antibiotics among inpatients was 2.67(2.00,3.42),which was significantly lower than 8.88(3.92,19.18)in the pre-practice group(Z=-3.26,P<0.05).There were no significant differences in the incidence of postoperative pulmonary infection and total length of hospital stay between the two groups(both P>0.05).Conclusion Clinical pharmacists participating in the management practice of perioperative prophylactic antibiotics in thoracic surgery can effectively promote the rational application of perioperative antibiotics,markedly improve the reasonable rate of prophylactic drug delivery,shorten the course of prophylactic drugs,reduce the cost of antibiotics,decrease the defined daily dose of antibiotics,without increasing the risk of postoperative pulmonary infection and the total length of hospital stay.