临床药师干预清洁手术围术期预防性应用抗菌药物的效果分析  

Effectiveness of Clinical Pharmacists' Intervention on Perioperative Use of Prophylactic Antibiotics in Patients Undergoing Sterile Operation

作　　者：张建华[1,2] 王瑞[1,2] 王清理[1,2] 裴媛[1,2] 贾明璐[1,2] 吴琪[1,2] 李森森[1,2] 

机构地区：[1]漯河医学高等专科学校第一附属医院 [2]漯河市中心医院,河南漯河462000

出　　处：《中国医院用药评价与分析》2013年第1期84-87,共4页Evaluation and Analysis of Drug-use in Hospitals of China

摘　　要：目的:评估某三级甲等医院清洁手术(Ⅰ类切口)围术期预防性应用抗菌药物情况与干预措施实施的效果。方法:对干预前(2009年1—12月)符合条件的548例清洁手术患者病历资料与干预后(2010年6月—2011年5月)的420例进行对比分析。结果:干预前的548例患者全部预防性应用了抗菌药物,预防性用药率为100%;术前0.5～2 h开始用药者96例(占17.5%),术前2～24 h开始用药者92例(占16.8%),术后开始用药者360例(占65.7%),术后平均预防性用药时间为5.21 d,平均抗菌药物费用为622.60元,平均住院费用为11 265.50元;干预后420例患者中有198例(占47.1%)未使用抗菌药物,术前0.5～2 h开始用药者28例(占6.7%),术后开始用药者22例(占5.2%),术后平均预防性用药时间为1.44 d,平均抗菌药物费用为176.19元,平均住院费用为8 724.70元,感染率与干预前相比差异无统计学意义。结论:清洁手术预防性应用抗菌药物不合理的现象在干预后有明显改善,但与卫生部清洁手术抗菌药物预防性使用率低于30%的要求仍有一定差距,亟待加强对外科医师规范化使用抗菌药物的管理和培训,保证临床用药安全、有效、经济。OBJECTIVE：To evaluate the perioperative use of prophylactic antibiotics in patients undergoing sterile operation in a three-A grade hospital and the effectiveness of the intervention on antibiotic use.METHODS： We compared the medical records of 548 cases collected before the intervention（from Jan of 2009 to Dec of 2009） with those of 420 cases after the intervention（from June 2010 to May 2011）.RESULTS： Of the total 548 cases collected before intervention,all（100%） received antibiotics,with 96 cases（17.5%） receiving antibiotics 0.5-2 hours before operation,92 cases（16.8%） 2-24 hours before operation,and 360 cases（65.7%） after operation;postoperatively,the prophylactic antibiotics were used for an average of 5.21 days;the mean cost of antibiotics was 622.60 Yuan,and the mean hospitalization cost was 11 265.50.Of the 420 cases after intervention,198 cases（47.1%） were not given antibiotics,with 28 cases（6.7%） receiving antibiotics 0.5-2 hours before operation and 22 cases（5.2%） after operation;postoperatively,the prophylactic antibiotics were used for an average of 1.44 days;the mean cost of antibiotics was 176.19 Yuan,and the mean hospitalization cost was 8 724.70 Yuan.The infection rate showed no statistical difference before and after intervention.CONCLUSION： The phenomena of irrational use of prophylactic antibiotics in patients undergoing sterile operation in a three-A grade hospital showed great improvement after intervention yet it is far from the requirement of Ministry of Health（which requires that the application rate of prophylactic antibiotics should be less than 30% in patients undergoing sterile operation）.It is urgent to strengthen management and training on surgeons regarding standardized application of antibiotics to achieve safe,effective and economic use of antibiotics.

关 键 词：清洁手术 围术期 抗菌药物 药学干预 

分 类 号：R978.1[医药卫生—药品]