骨科Ⅰ类切口患者围术期预防性应用抗生素情况及不合理用药分析

Perioperative prophylactic use of antibiotics of patients with classⅠincision in Orthopedics Department and its irrational analysis

目的分析医院骨科Ⅰ类切口患者围术期预防性应用抗生素情况,并对其不合理用药进行分析。方法回顾性分析2021年6月—2022年12月常熟市第一人民医院骨科行Ⅰ类切口手术并预防性应用抗生素患者92例的临床资料,记录患者手术类型、抗生素种类、术前给药时间及用药时长、不良反应。结果92例骨科Ⅰ类切口患者手术类型中,内固定术占比最高,占66.30%,其次为关节置换术,占17.39%;术前、术后用药中头孢唑林、头孢呋辛和头孢曲松占比均较高;给药时间在术前0.5~1 h者占比最高,为95.65%;用药时长≤24 h者占比最高,占85.87%;有23例(占25.00%)预防性应用抗生素不合理,主要不合理原因为药物选择不当(占56.52%)、给药时长不当(占17.39%)和用药疗程过长(占17.39%)。92例患者中在用药期间出现皮疹2例(占2.17%),恶心、呕吐4例(占4.34%),未见其他明显不良反应。结论医院骨科Ⅰ类切口患者围术期预防性应用抗生素存在不合理情况,主要为药物选择不当、给药时间不当和用药疗程过长,因此临床还需加强相关培训及管理,提高围术期预防性应用抗生素的合理性。

Objective To analyze the situation and irrationality of perioperative prophylactic use of antibiotics of patients with classⅠincision in Orthopedics Department.Methods Clinical data of 92 patients with classⅠincision and perioperative prophylactic use of antibiotics who discharged from Orthopedics Department of the Changshu First People′s Hospital from June 2021 to December 2022 were retrospectively analyzed,and type of surgery,antibiotics,preoperative administration time and duration,and adverse reactions were recorded.Results In terms of surgical type among the 92 patients with classⅠincision in Orthopedics Department,internal fixation accounted for the highest proportion(accounted for 66.30%),followed by joint replacement(accounted for 17.39%).Before and after surgery,cefazolin,cefuroxime and ceftriaxone among antibiotics accounted for the highest proportions.The proportion of drug administration was the highest at 0.5 to 1 h before surgery,was 95.65%,duration of antibiotic≤24 h was the highest(accounted for 85.87%).Among the 92 cases,23 cases(accounted for 25.00%)had irrational prophylactic antibiotic use,and the main irrational reasons were improper drug selection(accounted for 56.52%),improper drug administration time(accounted for 17.39%)and long drug treatment duration(accounted for 17.39%).There were 2 cases(accounted for 2.17%)of rash,4 cases(accounted for 4.34%)of nausea and vomiting,and no obvious adverse reactions in the rest of patients.Conclusion There are still irrational use of antibiotics in perioperative period for patients with classⅠincision in Orthopedics Department,mainly due to improper drug selection,improper administration time and long course of medication.Therefore,it is necessary to strengthen drug training and management in clinic to improve the rationality of perioperative preventive use of antibiotics.