临床药师干预骨折内固定装置取出术预防使用抗菌药物的效果评价与分析  

Effects Evaluation and Analysis of Clinical Pharmacists' Intervention on Prophylactic Use of Antibiotics in Removal of Internal Fixation Device for Fracture

作　　者：魏静[1,2] 孙晓娈[3] 陈婉琦 李歆[1,3] 

机构地区：[1]南京医科大学药学院,南京211166 [2]南京医科大学附属明基医院资材管理部,南京211166 [3]南京医科大学医政学院,南京211166

出　　处：《中国药房》2017年第14期1994-1998,共5页China Pharmacy

基　　金：国家自然科学基金面上项目(No.71673147);国家自然科学基金青年项目(No.71003055)

摘　　要：目的:评价临床药师干预骨折内固定装置取出术预防使用抗菌药物的效果。方法:选取某"三甲"医院2015年3-7月行骨折内固定装置取出术的患者117例为干预前组,2015年8月-2016年5月行上述手术的患者266例为干预后组。临床药师以该院《骨折内固定装置取出术预防使用抗菌药物合理性评价标准》为依据进行干预,比较干预前后两组患者预防使用抗菌药物的情况。结果:干预前后均未发现单次给药剂量不合理或需术中追加给药的患者。干预后,患者预防用抗菌药物使用率、无指征使用抗菌药物的比例、用药持续时间超过24 h的比例分别由干预前的84.6%、71.8%、48.7%下降至17.3%、9.8%、4.9%,且患者平均抗菌药物费用、全部药品费用占住院费用的比例和抗菌药物占全部药品费用的比例均较干预前显著降低,差异均有统计学意义(P<0.05);而干预前后药物选择不合理、首次预防用药时机不合理、联合用药不合理的患者比例,使用不同抗菌药物品种的比例,平均住院费用以及平均药品费用比较,差异均无统计学意义(P>0.05)。结论:临床药师的干预显著降低了骨折内固定装置取出术患者预防用抗菌药物的使用率,并改善了无指征用药情况,提高了预防使用抗菌药物的合理性;但仍然存在用药时机不合理、持续使用时间超过24 h等现象,仍需后续持续干预。OBJECTIVE： To evaluate the effects of clinical pharmacists＇ intervention on prophylactic use of antibiotics in removal of internal fixation device for fracture. METHODS： Totally 117 patients underwent removal of internal fixation device for fracture were selected from some on third grade class A hospital during Mar.-Jul. 2015 as pre-intervention group. Totally of 266 patients underwent removal of internal fixation device for fracture were selected during Aug. 2015-May 2016 as post-intervention group. Clinical pharmacists performed interventions based on Rationality Evaluation Criteria for Prophylactic Use of Antibiotics in Removal of lnternal Fixation Device for Fracture. The prophylactic use of antibiotics was compared between 2 groups before and af- ter intervention. RESULTS： No unreasonable single dose or additional drug during surgery was found before and after intervention. After intervention, utilization rate of antibiotics for prophylactic use, the proportion of patients receiving antibiotics without indications, the proportion of medication duration more than 24 h decreased from 84.6%, 71.8%, 48.7% to 17.3%, 9.8%, 4.9%, respectively. Average antibiotics cost, the proportion of total drug cost in hospitalization cost, the proportion of antibiotics cost in total drug cost were all decreased significantly compared to before intervention, with statistical significance （P〈0.05）. There was no statistical significance in the proportion of patients with unreasonable drug choice, unreasonable initial prophylactic medication timing and unreasonable drug combination, the proportion of different antibiotics types, average hospitalization cost and average drug cost （P〉0.05）. CONCLUSIONS： Clinical pharmacists＇ interventions significantly reduce the utilization rate of antibiotics for prophylactic use in patients underwent removal of internal fixation device for fracture, improve drug use without indications and rationality of prophylactic use of antibiotics. There still are problems, such as unr

关 键 词：临床药师 预防用药 抗菌药物 骨折内固定装置取出术 干预效果 

分 类 号：R969.3[医药卫生—药理学] R978.1[医药卫生—药学]