Ⅰ类切口手术围手术期预防用抗菌药物干预对照研究  

Antibiotics Use in Perioperative Period of Type Ⅰ Incision Operations by MTP Mode:A Comparative Study

作　　者：孙言才[1] 史天陆[1] 姜玲[1] 沈爱宗[1] 赵鹏[1] 

机构地区：[1]安徽医科大学附属省立医院药剂科,安徽合肥230001

出　　处：《中华医院感染学杂志》2010年第10期1447-1450,共4页Chinese Journal of Nosocomiology

基　　金：卫生部;WHO2008-2009合作项目课题资助(WP/2008/chn/04.07)

摘　　要：目的探讨甲状腺手术、乳腺手术、疝气修补术3种Ⅰ类切口手术围手术期预防用抗菌药物的合理性。方法选取两所三级甲等医院2008年3、9月份同期出院的3种Ⅰ类切口手术病历330例进行干预对照研究,干预组以3月份病历为调研基线,其后采用监测-培训-计划(MTP)模式实施干预;非干预组也以3月份病历为调研基线,但其后未用MTP模式进行干预。结果在干预组中,干预前后比较,抗菌药物应用率由100.00%下降到60.47%(P<0.05);用药品种前3位由头孢硫脒、青霉素、呋布西林更换为林可霉素、头孢唑林、头孢拉定;平均住院天数由9.45d下降到8.93d;平均药费由2433.05元下降到1732.22元(P<0.05);平均抗菌药物费用由988.17元下降到81.25元(P<0.05);在非干预组中,干预前抗菌药物应用率为100.00%,干预后仍为98.86%(P>0.05);用药品种前3位由头孢哌酮/舒巴坦、阿米卡星、头孢哌酮变化为左氧氟沙星、头孢哌酮、异帕米星;干预前平均住院天数为11.61d、干预后为13.02d;干预前平均药费为2860.87元,干预后为2636.89元(P>0.05);干预前平均抗菌药物费用为1067.43元,干预后为1220.17元(P>0.05)。结论干预组采用的MTP模式的干预方法可行、有效,能显著降低3种Ⅰ类切口手术围手术期预防用抗菌药物应用率,提高抗菌药物合理应用率,降低药物费用,其对促进临床安全、有效、经济的应用抗菌药物具有良好效果。OBJECTIVE To evaluate rational use of antibiotics for typeⅠ incision operations including thyroid surgery,breast surgery and hernioplasty in perioperative period by monitoring-training-planning（MTP）intervention model.METHODS The data of medications of two patients groups in two fertiary care hospitals in Mar or Sep 2008 were collected（totally 330 cases）and compared.Cases in March of intervention group were inquired as the baseline survey,and then preceded MTP mode of interventions.While non-intervention group cases in March were also inquired as the baseline survey,but subsequently were not interfered with the MTP mode.RESULTS In intervention group,compared pre-nd post-intervention,the percentage of antibiotics use was decreased from 100.00% to 60.47%（P〈0.05）.The first three antibiotics used were changed from cefathiamidine,penicillin sodium and furbucillin to lincomycin,cefazolin and cefradine.The average hospitalization days decreased from 9.45d to 8.93d.The former average drug expenses were 2433.05 yuan,while after intervention obviously declined to 1732.22 yuan（P〈0.05）.The average cost of antibiotics decreased from 988.17 yuan to 81.25 yuan（P〈0.05）.In non-intervention group,compared Pre-and post-intervention,the percentage of antibiotics use was decreased from 100.00% to 98.86%（P〈0.05）.The first three antibiotics used were changed from cefoperazone/sulbactam,amikacin,and cefoperazone to levofloxacin,cefoperazone and isepamicin.The average hospitalization days increased from 11.61d to 13.02d.The average drug expenses were 2860.87 yuan,and declined to 2636.89 yuan after intervention（P〈0.05）.The average cost of antibiotics increased from 1067.43 yuan to 1220.17 yuan（P〉0.05）.CONCLUSIONS The intervention-control study shows that MTP intervention mode is feasible and effective,which can significantly reduce antibiotic use,improve the rational use of antibiotics,reduce drug costs and well promote the safe,effective and economical clinical application of antibiotics.

关 键 词：Ⅰ类切口手术 围手术期 抗菌药物 合理性 监测-培训-计划模式 干预对照研究 

分 类 号：R978.1[医药卫生—药品]