综合目标考核对围手术期预防性应用抗菌药物的影响  

Impact of synthetic target evaluation system on prophylactic use of antibiotics during perioperative period

作　　者：邵华[1] 厉伟兰[1] 缪玉山[1] 石涛[1] 

机构地区：[1]东南大学附属中大医院临床药学室,江苏南京210009

出　　处：《中华医院感染学杂志》2011年第13期2782-2784,共3页Chinese Journal of Nosocomiology

摘　　要：目的调查综合目标考核对围手术期预防性应用抗菌药物的影响。方法抽查考核开始前后手术科室病历,比较预防应用抗菌药物选择、给药时机以及术后给药时间等,评价综合目标考核对围手术期预防性应用抗菌药物的影响。结果考核前后所有手术均预防性应用抗菌药物;术前<30 min～2 h用药考核前为15.0%,考核后为30.9%,差异有统计学意义(P<0.01),术后才开始预防性使用抗菌药物考核前为71.6%,考核后为50.2%,差异有统计学意义(P<0.01);Ⅰ、Ⅱ类切口手术在术后<3 d停药考核前为24.4%、2.9%,考核后为41.3%、27.7%,差异有统计学意义(P<0.01),考核后甲状腺、乳腺手术使用抗菌药物由18种降为10种,且绝大多数选择了头孢唑林,二、三代头孢菌素使用比例大幅下降,差异有统计学意义(P<0.05)。结论综合目标考核在一定程度上促进了手术科室合理性预防使用抗菌药物,但是距离《抗菌药物临床应用指导原则》的要求还相差甚远,需要相关人员共同努力提高。OBJECTIVE To investigate the impact of synthetic target evaluation system on the prophylactic application of antibacterials in peri-operative process. METHODS The samples of electronic medical records before and after synthetic target evaluation, were taken to compar the choice of antibacterials, opportunity of administration and duration to investigate the impact of synthetic target evaluation system on the prophylactic application of antibacterials during perioperative period. RESULTS Antibacterials had been prophylactically used in all records. Comparing with the data before evaluation, patients received first dose of antibacterials at 0.5-2 hours pro-operatively had obviously increased （15. 0% vs 30. 9%, P〈 0. 001） and inappropriate post-operative antimicrobial prophylaxis had decreased obviously （71.6 % vs 50.2%, P〈0. 001）. Proportions of patients that stopped the administration of antimicrohials in 3 days post-operatively in clean or clean-contaminated wounds had increased statisticly （24.4% vs 41.3%, 2.9% vs 27.7%, P〈0. 001）, and most of the choice of the antibacterials in the thyroidectomy/mammectomy was cefazolin, the choice of second and third generation of cephalosporin had decreased greatly （P〈0. 05）. CONCLUSION Synthetic target evaluation system promotes the rational use of antibacterials in the perioperative process, but it is still far away from the targets of Principles of the clinical application of antibacterials＇. All the healthcare workers should endeavor to reach the goals.

关 键 词：围手术期 抗菌药物 综合目标考核 

分 类 号：R978.1[医药卫生—药品]