Background Bacterial infections remain a serious complication following coronary artery bypass grafting (CABG). The objective of the study was to determine the effectiveness of a guideline for the appropriate use of...Background Bacterial infections remain a serious complication following coronary artery bypass grafting (CABG). The objective of the study was to determine the effectiveness of a guideline for the appropriate use of antibiotics in CABG during the perioperative period.Methods Six hundred and fourteen hospitalized patients who had undergone CABG from January to June 2006 were randomly allocated to an intervention group and a control group. The data on the hospital stay, days of antibiotic used, types of prophylactic antibiotics used, surgical wound infection and pulmonary infection and antibiotic costs for the patients were compared.Results The postoperative hospitalization days of the intervention group were significantly fewer than that for the control group (P 〈0.05). The time of antibiotic use and post-infection treatment time were also significantly less in the intervention group than in the control group (P 〈0.05). The average hospital daily cost and total cost of antibiotics were less in the intervention group than in the control group (P 〈0.05). Compared with the control group, prophylactic antibiotic use in the intervention group was more reasonable. Conclusions The guideline for the appropriate use of antibiotics in CABG during the perioperative period is effective strategies for reducing antibiotic costs, the time of antibiotic use and post-infection treatment time without compromising the patients' clinical outcome.展开更多
目的探索人工瓣膜术后患者华法林的出血不良事件及其影响因素,为真实世界华法林安全使用提供指导。方法采用回顾性分析的方法收集近5年来中国医学科学院阜外医院心脏外科因人工心脏瓣膜置换手术而服用华法林至少3个月的患者的相关临床...目的探索人工瓣膜术后患者华法林的出血不良事件及其影响因素,为真实世界华法林安全使用提供指导。方法采用回顾性分析的方法收集近5年来中国医学科学院阜外医院心脏外科因人工心脏瓣膜置换手术而服用华法林至少3个月的患者的相关临床信息。结果共纳入412例患者,其中39例(9.5%)患者发生了62例次出血事件。仅有3例发生大出血,其余均为非大出血。倾向性评分匹配前后,两组患者的年龄、身高、体重、身体质量指数(body mass index,BMI)、性别、合并疾病和合并用药方面无显著性差异,出血组国际标准化比值(internation normailzed ratio,INR)在治疗范围内时间的百分比(time in therapy range,TTR)显著高于非出血组(匹配前P=0.023,匹配后P=0.008),但INR在治疗范围内次数的百分比(percentage of INR determinations in range,PINNR)无显著差异。出血组患者INR>3的情况为4例次,平均INR值<3。除了鼻出血事件在术后第1个月发生率较高外,其他事件在术后前3个月的分布无明显差异。结论人工瓣膜术后华法林抗凝治疗绝大多数为非大出血事件,应为患者宣教诊疗相关基础疾病和纠正可逆转的出血风险因素的重要性。抗凝门诊可改善患者的TTR,但当INRs监测时间间隔不同时,TTRs是否能够反应真实的华法林抗凝质量应当存疑,尤其是间隔时间较短可能高估TTR值,此时选择PINNR更为合理。展开更多
文摘Background Bacterial infections remain a serious complication following coronary artery bypass grafting (CABG). The objective of the study was to determine the effectiveness of a guideline for the appropriate use of antibiotics in CABG during the perioperative period.Methods Six hundred and fourteen hospitalized patients who had undergone CABG from January to June 2006 were randomly allocated to an intervention group and a control group. The data on the hospital stay, days of antibiotic used, types of prophylactic antibiotics used, surgical wound infection and pulmonary infection and antibiotic costs for the patients were compared.Results The postoperative hospitalization days of the intervention group were significantly fewer than that for the control group (P 〈0.05). The time of antibiotic use and post-infection treatment time were also significantly less in the intervention group than in the control group (P 〈0.05). The average hospital daily cost and total cost of antibiotics were less in the intervention group than in the control group (P 〈0.05). Compared with the control group, prophylactic antibiotic use in the intervention group was more reasonable. Conclusions The guideline for the appropriate use of antibiotics in CABG during the perioperative period is effective strategies for reducing antibiotic costs, the time of antibiotic use and post-infection treatment time without compromising the patients' clinical outcome.
文摘目的探索人工瓣膜术后患者华法林的出血不良事件及其影响因素,为真实世界华法林安全使用提供指导。方法采用回顾性分析的方法收集近5年来中国医学科学院阜外医院心脏外科因人工心脏瓣膜置换手术而服用华法林至少3个月的患者的相关临床信息。结果共纳入412例患者,其中39例(9.5%)患者发生了62例次出血事件。仅有3例发生大出血,其余均为非大出血。倾向性评分匹配前后,两组患者的年龄、身高、体重、身体质量指数(body mass index,BMI)、性别、合并疾病和合并用药方面无显著性差异,出血组国际标准化比值(internation normailzed ratio,INR)在治疗范围内时间的百分比(time in therapy range,TTR)显著高于非出血组(匹配前P=0.023,匹配后P=0.008),但INR在治疗范围内次数的百分比(percentage of INR determinations in range,PINNR)无显著差异。出血组患者INR>3的情况为4例次,平均INR值<3。除了鼻出血事件在术后第1个月发生率较高外,其他事件在术后前3个月的分布无明显差异。结论人工瓣膜术后华法林抗凝治疗绝大多数为非大出血事件,应为患者宣教诊疗相关基础疾病和纠正可逆转的出血风险因素的重要性。抗凝门诊可改善患者的TTR,但当INRs监测时间间隔不同时,TTRs是否能够反应真实的华法林抗凝质量应当存疑,尤其是间隔时间较短可能高估TTR值,此时选择PINNR更为合理。