骨科脊柱不同类型Ⅰ类切口手术围术期预防性应用抗菌药物680例分析

Analysis of perioperative prophylactic application of antimicrobial drugs for typesⅠin 680 cases of different types of orthopedic spine surgery

目的分析骨科脊柱不同类型Ⅰ类切口手术围术期预防性应用抗菌药物的情况,为临床应用与管理提供参考。方法采用回顾性调查研究,调取2019年1—12月宁夏回族自治区某三级甲等医院骨科脊柱Ⅰ类切口手术病例680例,分析患者手术类型、手术时间、抗菌药物预防性使用率、品种选择、给药时机及疗程。结果680例病例中,手术时间≤2 h的病例360例,占比为52.94%;手术时间>3 h的病例198例,占比为29.12%。预防性使用抗菌药物476例,预防性使用率为70.00%。围术期预防性应用抗菌药物主要分布在各类融合术、各类内固定术及装置植入术、各类病灶切除及活检术,合计占比为93.06%。预防性应用抗菌药物主要选用头孢唑林296例(62.19%)、头孢呋辛132例(27.73%)。术前0.5~1 h内给药450例,占比为94.54%。疗程≤24 h的病例占比为59.67%,>48 h的病例占比为28.99%。结论该院骨科脊柱不同类型Ⅰ类切口手术围术期预防性应用抗菌药物基本合理,但仍存在一些问题,有待进一步规范化管理,提高合理用药水平。

Objective To analyze prophylactic use of antibiotics in different types of spine typeⅠincision surgery,to provide reference for clinical application and management.Methods A retrospective study was conducted to collect 680 cases of orthopedic spine typeⅠincision surgery in a grade 3A hospital in Ningxia Hui Autonomous Region from January to December 2019,and the type of surgery,operation time,antimicrobial prophylactic use rate,species selection,timing of drug administration,and duration of treatment were analyzed.Results Of the 680 cases,360 cases(52.94%)were operated for≤2 hours,and 198 cases(29.12%)were operated for>3 hours.Prophylactic use of antimicrobial drugs was used in 476 cases,and the rate of prophylactic use was 70.00%.The perioperative prophylactic application of antimicrobial drugs was mainly distributed in various types of fusion,various types of internal fixation and device implantation,and various types of lesion excision and biopsy,with a combined percentage of 93.06%.Prophylactic application of antimicrobial drugs was mainly used in 296 cases of cefazolin(62.19%)and cefuroxime 132 cases(27.73%).Drugs were administered within 0.5 to 1 hours preoperatively in 450 cases(94.54%).The percentage of cases with a duration of treatment≤24 hours was 59.67%,while the percentage of cases with a duration of>48 hours was 28.99%.Conclusion The perioperative prophylactic medication of different types of typeⅠincision surgery in orthopedic department of the hospital is basically reasonable,but there are still some problems,which need to be further standardized management and improve the level of rational drug use.