腹腔镜胆囊切除术治疗慢性胆囊炎患者预防应用抗菌药物合理性分析

Analysis of the rationality of prophylactic use of antibiotics in laparoscopic cholecystectomy for patients with chronic cholecystitis

目的了解腹腔镜胆囊切除术(LC)治疗胆石症引起的慢性胆囊炎患者围手术期预防应用抗菌药物的合理性。方法回顾性选取我院2022年1月至2023年1月收治的166例行LC治疗的胆石症引起的慢性胆囊炎患者作为研究对象,调查其围术期预防性应用抗菌药物情况,并分析抗菌药物在品种选择、用药疗程、给药时机等方面的合理性。结果品种选择:166例患者应用的抗菌药物品种较多:头孢替安152例(91.6%)、依诺沙星5例(3.0%)、头孢哌酮钠舒巴坦钠4例(2.4%)、头孢他啶2例(1.2%)、左氧氟沙星氯化钠1例(0.6%)。除3例为二联用药外,163例(98.2%)均为单一用药,且91.6%单用注射用盐酸头孢替安。用药时机:除2例为术前0.5~1 h用药外,164例(98.8%)患者均为术后用药,无术中用药。用药疗程:术后用药时长以<24 h为主(159例,95.8%),2例(1.2%)用药时长为24~48 h,5例(3.0%)用药时长为48~72 h,1例(0.6%)用药时长≥72 h。合理性评价:166例患者在联合用药(164例,98.8%)、给药途径(166例,100%)、用法用量(166例,100%)及用药疗程(159例,95.8%)的合理性较高,给药时机的合理性最低(2例,1.2%),用药指征合理性偏低,为74.1%(123例),药物选择方面的合理性为89.1%(148例),整体用药合理率为79.86%(928例)。25例(15.1%)患者发生消化道相关症状的近期并发症,包括腹痛腹胀(8例,4.8%)、腹泻(10例,6.0%)、恶心呕吐(7例,4.2%)。有并发症与无并发症患者在用药指征、药物选择、给药时机、联合用药、给药途径、用法用量、用药疗程方面的用药合理性对比,差异均无统计学意义(P>0.05)。结论我院胆石症引起的慢性胆囊炎患者在LC围术期预防性应用抗菌药物总体较为合理,但仍然存在用药时机不当、无适应证用药、抗菌药物选用不合理等问题。

Objective To investigate the rationality of perioperative prophylactic use of antibiotics in laparoscopic cholecystectomy(LC)for patients with chronic cholecystitis.Methods A retrospective study was conducted on 166 patients with chronic cholecystitis caused by cholelithiasis treated with LC in our hospital from January 2022 to January 2023.The prophylactic use of antibiotics during the perioperative period was investigated,and the rationality of antibiotics in terms of variety selection,course of treatment,and timing of administration were analyzed.Results Variety selection:166 patients had a wide variety of antibiotics used[cefoperam in 152 cases(91.6%),enoxacin in 5 cases(3.0%),cefoperazone sodium sulbactam sodium in 4 cases(2.4%),cefotaxime in 2 cases(1.2%),levofloxacin sodium chloride in 1 case(0.6%)].Except for 3 cases of combination therapy,163 cases(98.2%)were all given monotherapy,and 91.6%only used cefoperam chloride for injection.Medication timing:Except for 2 cases of medication at 0.5~1 h before surgery,164 patients(98.8%)received postoperative medication,and there was no intraoperative medication.The postoperative medication duration was mainly less than 24 h(159 cases,95.8%),in 2 cases(1.2%)it was 24~48 h,in 5 cases(2.4%)it was 48~72 h,and 1 case(0.6%)had medication duration≥72 h.Reasonability evaluation:166 patients had higher rationality in combination medication(164 cses,98.8%),administration route(166 cases,100.0%),dosage(166 cases,100.0%),and course of treatment(159 cases,95.8%),the lowest rationality in administration timing(2 cases,1.2%),and lower rationality in medication indications(123 cases,74.1%).The rationality of drug selection was 89.1%(148 cases),and the overall rational drug use rate was 79.86%(928 cases).Totally 25 cases(15.1%)developed recent complications related to gastrointestinal symptoms.The symptoms included abdominal pain and bloating(8 cases,4.8%),diarrhea(10 cases,6.0%),and nausea and vomiting(7 cases,4.2%).There was no statistically significant difference(P>0.05)between patients with and without complications in terms of medication indications,drug selection,timing of administration,combination therapy,route of administration,dosage,and duration of medication(P>0.05).Conclusion The prophylactic use of antibiotics in patients with chronic cholecystitis caused by gallstones in our hospital during the perioperative period of LC is generally reasonable,but there are still problems such as improper medication timing,no indication for medication,and unreasonable antibiotic selection.