某综合医院骨科Ⅰ类切口手术围术期抗菌药物应用合理性评价

Evaluation of perioperative antimicrobial drug rationality in orthopaedic category I incision surgery in general hospitals

目的:通过对我院骨科Ⅰ类切口手术围术期抗菌药物应用情况的分析对其合理性进行评价,以达到发现抗菌药物不合理问题,探索原因、提升骨科乃至全院抗菌药物规范合理应用的目的。方法:选取我院2021年1月-2022年12月骨科收治的Ⅰ类切口手术患者病历资料共计648份,统计患者年龄、性别、临床诊断等基本资料,以及骨科Ⅰ类切口手术构成、不同术式围术期抗菌药物预防性使用情况、抗菌药物品种选择、给药时机、疗程等综合分析,参照《抗菌药物临床应用管理办法》《抗菌药物临床应用指导原则》等对围术期用药合理性进行评价。结果:648例患者平均年龄(51.6±18.5)岁;预防性使用抗菌药物病例数558例(占86.11%),未使用抗菌药物病例数90例(占13.89%)。所有Ⅰ类切口手术围术期抗菌药物使用单一品种,品种选择以一、二代头孢菌素为主,用法用量、溶媒符合要求。围术期预防性使用抗菌药物不合理病例82例(占12.65%),主要不合理原因为预防用药无指征、药物遴选不适宜和用药时机不当以及疗程过长等。结论:本院骨科Ⅰ类切口围术期抗菌药物应用合理率较高,但抗菌药物应用仍存在预防用药比例偏高,且存在药物遴选不适宜、预防用药初次给药时机和疗程不合理现象,需要医药护协同推进骨科Ⅰ类切口围术期抗菌药物应用水平,降低用药风险及医药经济负担,促进合理用药。

Objective By analysing the perioperative antimicrobial drug application cases of Class I incision surgery in our orthopaedic department and evaluating the reasonableness of the cases,in order to find out the unreasonable problems of antimicrobial drugs,explore the causes,and enhance the standardized and reasonable application of antimicrobial drugs in orthopaedic department and even in the whole hospital.Methods A total of 648 medical records of Class I incision surgery patients admitted to the Department of Orthopaedic Surgery of our hospital from January 2021 to December 2022 were selected,and basic data such as patients'age,gender,clinical diagnosis,etc.,as well as the composition of Class I incision surgery of orthopaedic surgery,the prophylactic use of antimicrobials in the perioperative period of different surgical procedures,the choice of antimicrobial drug varieties,the timing of administration,and the duration of treatment were analysed comprehensively,with reference to the"Measures for the Administration of Clinical Application of Antimicrobial Drugs"and"Guiding Principles for Clinical Application of Antimicrobial Drugs",etc.to evaluate the rationality of perioperative drug use.Results The average age of 648 patients was(51.6±18.5);The number of cases with prophylactic use of antimicrobial drugs was 558(86.1%),and the number of cases without the use of antimicrobial drugs was 90(13.8%).All Class I incision surgery perioperative antimicrobial drugs use a single species,species selection to the first and second generation of cephalosporin-based,dosage,solvents in line with the requirements.There were 82 cases of unreasonable perioperative prophylactic use of antimicrobial drugs(accounting for 12.7%),with the main unreasonable reasons being that prophylactic use of drugs was not indicated,the timing of the use of drugs was inappropriate,and the course of treatment was inappropriate.Conclusions The perioperative antimicrobial drug application rate of orthopaedic class I incision in this medical institution is relatively high,but there still exists a high proportion of prophylactic drug application,and there are the phenomena of inappropriate drug selection,inappropriate timing of the initial administration of prophylactic drugs,and irrational course of treatment,so it is necessary to collaborate with the medicine and nursing care to promote the level of perioperative antimicrobial drug application of orthopaedic class I incision,to reduce the risk of medication and the medical and economic burdens,and to promote the rational use of medication.