临床路径在结直肠癌患者围手术期预防性使用抗菌药物中的应用  

Application of clinical pathway in prophylactic use of antibiotics during perioperative period of colorectal cancer surgery

作　　者：李斌[1] 冯联忠[1] 董来荣[1] 曹晨曦[1] 付斌[1] 

机构地区：[1]嘉兴市第二医院普外科,浙江嘉兴314000

出　　处：《中华医院感染学杂志》2013年第22期5519-5521,共3页Chinese Journal of Nosocomiology

基　　金：嘉兴市科技局科技基金项目(2012AY1071-10)

摘　　要：目的探讨临床路径在结直肠癌围手术期预防性使用抗菌药物中的作用和意义,以提高预防性使用抗菌药物的合理性。方法将医院肿瘤外科2011年1月1日-12月31日完成临床路径管理的结直肠癌手术患者49例为临床路径组;2009年5月1日-2010年4月30日未实施临床路径的结直肠癌手术患者42例为对照组,观察比较两组患者围手术期预防性使用抗菌药物的合理性及手术部位感染、吻合口漏等术后并发症发生情况等指标。结果两组患者围手术期均有预防性应用抗菌药物,两组术后无手术部位感染及吻合口漏的发生;临床路径组在围手术期预防性使用抗菌药物不规范化用药发生率为29.55%,明显低于对照组的62.5%(P<0.05),临床路径组的预防性使用抗菌药物合理率为70.45%,明显高于对照组的37.5%(P<0.05),不合理率9.09%明显低于对照组的30.00%,差异有统计学意义(P<0.05)。结论实施临床路径管理能促进结直肠癌围手术期预防性使用抗菌药物的合理应用,具有良好的经济、社会效益,值得推广。OBJECTIVE To investigate the role and significance of clinical pathway in the prophylactic use of antibiotics during the perioperative period of colorectal cancer surgery so as to improve the rationality of antibiotics prophylaxis. METHODS Totally 49 patients who underwent colorectal cancer surgery through clinical pathway in the tumor surgery department from Jan 1 to Dec 31, 2011 were assigned as the clinical pathway group, while 42 patients who underwent colorectal cancer surgery from May 1,2009 to Apr 30,2010, without the clinical pathway having been implemented, were set as the control group, then the indicators, including the rationality of antibiotics prophylaxis and the postoperative complications such as the surgical site infections and anastomotic leakage, were observed and compared between the two groups. RESULTS The patients of both groups have used antibiotics forprophylaxis during the perioperative period, and the surgical sites infections and the anastomotic leakage have not occurred. The incidence of unreasonable prophylactic use of antibiotics during the perioperative period was 29. 55% in the clinical pathway group, significantly lower than 62. 5% of the control group （P〈0.05）; the rate of reasonable prophylactic use of antibiotics of the clinical pathway group was 70. 45%, significantly higher than 37. 5% of the control group （P〈0.05）, the rate of unreasonable use of antibiotics of the clinical pathway group was 9.09%, significantly lower than 30. 00% of the control group, the difference was statistically significant （P〈0. 05）. CONCLUSION The implementation of clinical pathway management can promote the reasonable prophylactic use of antibiotics during the perioperative period of colorectal cancer surgery and produce good economic and social benefit, it is worthy to be promoted.

关 键 词：临床路径 结直肠癌 围手术期 抗菌药物 

分 类 号：R978.1[医药卫生—药品]