神经外科Ⅰ类切口围手术期抗菌药物预防使用药学路径的回顾性评价

Retrospective evaluation of the pharmaceutical pathway for prophylactic use of antibiotics during the perioperative period of classⅠneurosurgery incisions

目的探讨神经外科Ⅰ类切口手术患者围手术期预防使用抗菌药物药学路径的可行性。方法运用前期建立的神经外科Ⅰ类切口手术患者围手术期预防使用抗菌药物药学路径,回顾性评估127例神经外科Ⅰ类切口手术患者围手术期预防使用抗菌药物的情况,运用药学路径中“抗菌药物预防使用评分体系”进行术前评分,并与患者实际用药情况比较,结合现有《抗菌药物临床应用指导原则(2015版)》(以下简称为《指导原则》)进行分析。对于术中抗菌药物追加次数及术后抗菌药物预防使用时间,药学路径也创新性提出可改进的关键点,通过与患者实际的用药情况进行了对比,探讨《指导原则》可尝试更新的方向。结果依据回顾性分析结果,神经外科Ⅰ类切口手术中除了《指导原则》已建议的不推荐颅骨肿物切除术和颈动脉内膜切除术患者术前预防使用抗菌药物外,内镜下三叉神经微血管减压术、关节镜其他特指关节检查、脊神经根减压术、内镜下腰椎髓核切除术、硬脊膜修补术、椎管减压术手术也可进一步探索术前不预防性使用抗菌药物;同时,对于神经外科Ⅰ类切口手术患者术中、术后抗菌药物的使用,结合手术时间术中可考虑进行第2次追加抗菌药物,手术患者如出现脑脊液漏,建议可适当延长抗菌药物预防使用时间。结论药学路径的应用可更有针对性地分析抗菌药物预防使用的关键点,推动了Ⅰ类切口围手术期抗菌药物管理方式从“定性、经验”的管理向“定量、科学”的管理转型。

OBJECTIVE To explore the practicality of the pharmaceutical pathway for prophylactic use of antibiotics during the perioperative period of classⅠneurosurgery incisions.METHODS The previously established pharmaceutical pathway for the prophylactic use of antibiotics in the perioperative period of classⅠneurosurgery incisions was used to retrospectively evaluate the prophylactic use of antibiotics in 127 cases.The“antibiotics prophylactic use scoring system”in the pharmaceutical pathway was used to conduct preoperative scoring,and the patient’s actual antibiotics use was compared and analyzed in combination with existing Guiding Principles for Clinical Application of Antibiotics(2015 Edition)(hereinafter referred to as the Guiding Principles).The pharmaceutical pathway also innovatively proposes key points for improvement in terms of the frequency of adding antibiotics during surgery and the duration of prophylactic use of antibiotics after surgery.By comparing with the actual medication situation of patients,the direction for updating the Guiding Principles was explored.RESULTS According to the retrospective analysis results,for neurosurgery classⅠincision surgery,in addition to the preoperative prophylactic use of antibacterial drugs for skull mass resection and carotid endarterectomy recommended in the guidelines,endoscopic trigeminal microvascular decompression,arthroscopy and other specific joint examinations,spinal nerve Radical decompression,endoscopic lumbar nucleectomy,dural repair,and spinal canal decompression can also be further explored about the situation of not using antibacterial prophylaxis before surgery;at the same time,for the patients undergoing classⅠneurosurgery incisions,the use of antibiotics during and after surgery may be considered for a second addition of antibiotics,taking into account the surgical time.If cerebrospinal fluid leakage occurred after surgery,it is recommended to extend the duration of prophylactic use of antibiotics appropriately.CONCLUSIONS The application of pharmaceutical pathways can provide more targeted analysis of key points in the prevention of antibiotic use,which promotes the transformation of perioperative antibiotics management for classⅠincisions from“qualitative,empirical”management to“quantitative,scientific”management.