北大医疗鲁中医院干预前后骨科Ⅰ类切口围术期抗菌药物应用分析

李　云(北大医疗鲁中医院药剂科，山东 淄博　255434)



北大医疗鲁中医院干预前后骨科Ⅰ类切口围术期抗菌药物应用分析

李云*(北大医疗鲁中医院药剂科，山东 淄博255434)

DOI10.14009/j.issn.1672-2124.2016.02.033

摘要目的：分析干预前后骨科Ⅰ类切口围术期预防应用抗菌药物的效果。方法：采用回顾性调查方法，随机抽取2013年198例(干预前)及 2014年205例(干预后)骨科Ⅰ类切口手术病历，对干预前、后抗菌药物应用的合理性进行评价。结果：经临床药师干预后，骨科Ⅰ类切口手术患者围术期预防应用抗菌药物的预防使用率、药物选择、联合用药、用药时机与疗程等方面较干预前均有明显改善。预防使用率由干预前的100.00%(198/198)下降到38.05%(78/205)；干预前组患者术前0.5～2 h或麻醉开始时给药率为16.16%(32/198)，干预后组提高至94.87%(74/78)；术后24 h内停药者由2.53%(5/198)增加至78.21%(61/78)，用药疗程>72 h者由84.34%(167/198)下降到5.13%(4/78)。干预后，联合用药使用率为0。结论：经过临床药师干预抗菌药物不合理应用的现象得到了很大改善，但在预防使用率、使用疗程等方面仍需要继续改进。

关键词抗菌药物； Ⅰ类切口； 围术期； 临床药师

Analysis on Application of Antibiotics in ClassⅠIncision of PKU Care Luzhong Hospital Orthopedic Surgery during Perioperative Period

LI Yun(Dept.of Pharmacy, PKU Care Luzhong Hospital, Shandong Zibo 255434, China)

ABSTRACTOBJECTIVE：To analyze the application effects of antibiotics in classⅠincision of orthopedic surgery during perioperative period before and after intervention. METHODS: Retrospective investigation method was adopted, the medical records of 198 cases in 2013 (before intervention) and 205 cases in 2014 (after intervention) with orthopedic surgery were selected randomly to evaluate the rationality. RESULTS: After intervention of clinical pharmacists, the application of perioperative prophylactic antibiotics in orthopaedic surgery had been improved significantly in respect of the prophylactic utilization rate, drug selection, drug combination, administration time and treatment course, etc. The prophylactic utilization rate decreased from 100.00%(198/198)to 38.05%(78/205). The administration rate before intervention and surgery of 0.5～2 h or anesthesia was 16.16%(32/198), the intervention group increased to 94.87%(74/78); drug withdrawal within 24 h increased from 2.53%(5/198) to 78.21%(61/78). Treatment course over 72 h decreased from 84.34%(167/198) to 5.13%(4/78). After intervention, the drug combination rate was 0. CONCLUSIONS: The irrational application of antibiotics has been significantly ameliorated by the special rectification of clinical pharmacists, yet the preventive usage and treatment course still need to be improved.

KEYWORDSAntibiotics; ClassⅠincision; Perioperative; Clinical pharmacists

原卫生部2011年6月起要求开展抗菌药物专项整治活动，抗菌药物合理使用已经成为医院管理的重要组成部分。围术期应用抗菌药物可以预防内源性感染的发生。在骨科围术期的治疗中，抗菌药物的合理应用既可以起到防治效果，又可以增加手术安全性、提高治愈率[1]。但临床药师在日常工作中发现，围术期预防使用抗菌药物也存在着诸多不合理现象，故本调查以抗菌药物专项整治活动为契机，通过与相关职能部门联合，对不合理用药进行考核和惩罚，并对2013年和2014年骨科Ⅰ类切口手术患者抗菌药物应用情况进行对比研究，现报告如下。