清洁切口手术围手术期抗菌药物预防应用的干预研究  

Intervention in perioperative antimicrobial prophylaxis in clean incision operation

作　　者：冉素平[1] 贾莉萍[1] 顾颖[1] 刘欣波[1] 

机构地区：[1]解放军第306医院,北京100101

出　　处：《中国感染控制杂志》2016年第5期330-333,共4页Chinese Journal of Infection Control

摘　　要：目的了解清洁切口手术围手术期抗菌药物预防应用情况及干预效果,促进临床合理使用抗菌药物。方法监测某院Ⅰ类切口手术患者,2013年3月为干预前组,2014年3月为干预后组。2013年8月底开始在全院范围内开展抗菌药物临床应用专项整治活动,比较两组患者围手术期抗菌药物预防性使用情况。结果干预前后分别调查清洁切口手术患者367、324例,干预后清洁切口手术患者围手术期抗菌药物预防使用率低于干预前（46.60%vs 77.38%）（P〈0.001）;预防使用抗菌药物的患者中,干预前后联合用药比率分别为18.66%和4.64%,联合用药率下降,干预后已多采用单一用药。术前0.5~2 h或麻醉诱导开始时给药：干预前占43.66%,干预后占54.30%,术前用药比率上有所增高（P〈0.05）;用药持续时间≤48 h：干预前后分别占9.15%和29.14%,用药持续时间明显降低（P〈0.001）。使用抗菌药物以头孢菌素类为主,干预前组使用的主要为头孢呋辛、头孢曲松和头孢米诺;干预后组主要为头孢呋辛、克林霉素和头孢米诺。结论通过抗菌药物临床应用专项整治活动提高了清洁切口手术围手术期抗菌药物应用的合理性,应进一步加强干预措施的实施力度,使得围手术期预防用药更加规范;医院感染;合理用药。Objective To understand perioperative antimicrobial prophylaxis in clean incision operation and intervention effect,promote rational use of antimicrobial agents.Methods Patients with typeⅠincision operation in a hospital were monitored,March 2013 was as pre-intervention group,March 2014 was as post-intervention group.Special rectification activities on clinical application of antimicrobial agents in hospital was carried out from August2013,perioperative antimicrobial prophylaxis in two groups was compared.Results Before and after intervention,367 and 324 cases of clean incision operation were investigated,perioperative antimicrobial prophylaxis in patients undergoing clean incision operation after intervention was lower than before intervention（46.60% vs 77.38%,P〈0.001）;among patients with prophylactic use of antimicrobial agents,usage rates of combined antimicrobial agents decreased from18.66% before intervention to 4.64% after intervention,single application of antimicrobial agents was adopted after intervention.Medication 0.5-2 h preoperative and at the beginning of anesthesia induction before and after intervention were 43.66% and 54.30% respectively,preoperative medication rate increased（P〈0.05）;duration of medication≤48 h before and after intervention were 9.15%and29.14%respectively,duration of medication decreased obviously（P〈0.001）.The main used antimicrobial agents were cephalosporins,before intervention were cefuroxime,ceftriaxone,and cefminox;after intervention were cefuroxime,clindamycin,and cefminox.Conclusion Special rectification activities on clinical application of antimicrobial agents improved the rationality of perioperative antimicrobial use in clean incision operation,implementation of intervention measures should be further strengthened,and make perioperative prophylactic use more standardized.

关 键 词：抗菌药物 清洁切口手术 围手术期 医院感染 合理用药 

分 类 号：R978.1[医药卫生—药品]