Ⅰ类切口手术部位感染与围术期预防性抗菌药物应用研究  

Surgical site infections induced by type I incision surgery and prophylactic use of antibiotics during perioperative period

作　　者：王飞[1] 张秀月[1] 万书[1] 卢岩[1] 施红[1] 齐月[1] 孙明珠[1] 

机构地区：[1]中国医科大学附属盛京医院医院感染管理办公室,辽宁沈阳110004

出　　处：《中华医院感染学杂志》2014年第10期2411-2413,共3页Chinese Journal of Nosocomiology

基　　金：中华医学会基金资助项目(09-977);辽宁省自然科学基金资助项目(20102284)

摘　　要：目的观察Ⅰ类切口手术预防性抗菌药物应用的干预效果,探讨其对手术部位感染的影响。方法监测医院2011-2013年Ⅰ类切口手术患者围术期预防性抗菌药物应用与手术部位感染发生情况;2011年1-6月为基线阶段,2012年和2013年1-6月为连续干预后两个阶段,监测内容主要包括抗菌药物使用率、人均用药天数、应用时机合理性及使用种类等变化趋势,并统计同期的Ⅰ类切口手术部位感染率。结果Ⅰ类切口手术围术期预防性抗菌药物使用率由91.2%下降至84.0%、66.1%,差异有统计学意义(P<0.01),人均用药天数由8.4d减少到4.1d;预防性抗菌药物应用时机和时间也更为合理,选择种类也更为规范,术前30min^2h应用抗菌药物比例由22.0%逐步提升至35.1%、46.4%(P<0.05);术中追加抗菌药物比例由11.7%增高至23.5%(P<0.05);预防性应用抗菌药物术后1、2d停药比例分别由19.4%、20.4%提高到31.0%、40.1%(P<0.05);预防性应用单种抗菌药物比例由23.5%显著提升至51.9%、72.5%,差异有统计学意义(P<0.01);预防性抗菌药物种类选择第一、二代头孢菌素比例明显升高,由26.2%提高至54.6%(P<0.01);同期的Ⅰ类切口手术部位感染率由3.5‰逐渐下降至2.9‰、1.4‰,差异有统计学意义(P<0.01)。结论Ⅰ类切口手术围术期预防性抗菌药物干预有效,手术部位感染率明显降低,合理和规范预防性抗菌药物应用有待进一步加强。OBJECTIVE To observe the effect of intervention to prophylactic use of antibiotics for the type I incision surgery and explore the impact on surgical site infections. METHODS From 2011 through 2013, the perioperative prophylactic use of antibiotics and the incidence of surgical site infections in the patients undergoing type I inci- sion surgery were monitored, then the time from Jan to Jun 2011 was set as the baseline period, the time of 2012 and the time from Jan to Jun 2013 were set as the two post-intervention periods, the major monitoring indicators included the utilization rate of antibiotics, average medication duration, rationality of timing of use of antibiotics, and types of antibiotics used, and the incidence rates of the surgical site infections were statistically analyzed. RESULTS The utilization rate of prophylactic antibiotics during the perioperative period of the type I incision sur- gery decreased from 91.2 % to 84.0 % and 66.1%, the difference was significant（P〈0.01） ; the average medica- tion duration decreased from 8.4 days to 4.1 days; the timing of prophylactic use of antibiotics tended to be more reasonable, and the choice of antibiotics was more standardized; the proportion of the patients who used antibiotics at 0.5-2 hours before the surgery increased from 22.0% to 35.1% and 46.4% （P〈0.05） ; the proportion of the patients who were intraoperatively treated with additional antibiotics increased from 11. 7% to 23. 5% （P〈0.05 %）; the proportion of the patients who were withdrawn the prophylactic antibiotics 1 day or 2 days after the surgery respectively increased from 19.4% and 20.4% to 31.0% and 40.1% （P〈0.05） ; the proportion of the patients who used single prophylactic antibiotic increased significantly from 23. 5 % to 51.9% and 72. 5 %, the difference was significant （P〈0.01）; the proportion of the patients who used the first or second generation cepha- losporins as the prophylactic antibiotics increased from 26.2% to 54.6% （P〈0.01）. The incidence of

关 键 词：I类切口 围术期 手术部位感染 预防性抗菌药物 

分 类 号：R978.1[医药卫生—药品]