心脏外科Ⅰ类切口预防用抗菌药物路径式专项管理效果研究  

Effect of the management of specific pathway on antibiotic prophylaxis for classⅠincision in cardiac surgery

作　　者：石秀锦[1] 秦英[1] 方振威[1] 郑青敏[1] 刘治军[1] 王海燕[1] 魏娟娟[1] 徐晓宇[1] 林阳[1] SHI Xiu-jin;QIN Ying;FANG Zhen-wei;ZHENG Qing-min;LIU Zhi-jun;WANG Hai-yan;WEI Juan-juan;XU Xiao-yu;LIN Yang(Department of Pharmacy,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院药事部,北京100029

出　　处：《中国药物应用与监测》2018年第5期298-302,共5页Chinese Journal of Drug Application and Monitoring

基　　金：北京市医院管理局临床医学发展专项经费资助项目(ZYLX201805)

摘　　要：目的:探讨我院心脏外科Ⅰ类切口手术预防用抗菌药物路径式合理应用管理对抗菌药物使用情况及术后感染率的影响。方法:采用回顾性研究的方法,对路径式管理前后我院心脏外科病房住院患者抗菌药物用药频度(DDDs)、使用强度(AUD)、使用金额、常用抗菌药物种类及术后感染率进行统计分析。结果:路径式管理后,心脏外科病房2017年12月住院患者抗菌药物使用强度与2016年12月相比同比下降33.60%(28.77/85.62)、与2017年11月相比环比下降29.06%(23.29/80.14),使用金额同比下降66.02%(185.72/281.30)、环比下降52.49%(105.64/201.22),用药频度同比下降40.49%(4325/10 680)、环比下降34.62%(3366/9721),而术后感染率差异无统计学意义(P> 0.05)。同时心外科医生反映许多观念已改变,对部分感染风险较低的心脏手术患者做到了术后24 h停药,取得了良好的成效。结论:路径式管理规范了我院心脏外科手术围手术期抗菌药物的使用,减少了抗菌药物的过度使用而不增加术后感染率。Objective： To explore the effect of the management of specifc pathway on the utilization of antibacterials and the incidence of postoperative infection in class Ⅰ incision cardiac surgery in our hospital. Methods： The defned daily dose （DDDs） of antibiotics, antimicrobial use density （AUD）, consumption fee, types of antibiotics and incidence of postoperative infection before and after management were analyzed retrospectively. Results： After management, AUD decreased by 33.60% （28.77/85.62） year-on-year and 29.06% （23.29/80.14） month-on-month. The consumption fee decreased by 66.02% （185.72/281.30） year-on-year and 52.49% （105.64/201.22） month-on-month. The frequency of medication decreased by 40.49% （4325/10 680） year-on-year and 34.62% （3366/9721） month-on-month. There was no signifcant difference in incidence of postoperative infection （P 〉 0.05）. At the same time, ideas of cardiac surgeons were changed. Time of antibiotic prophylaxis for some patients with low risk of infection was no more than 24 hours. Conclusion： The management of specifc pathway could promote the reasonable antibiotic prophylaxis for class Ⅰincision cardiac surgery and decrease the overuse of antibiotics without high incidence of postoperative infection.

关 键 词：心脏外科 预防用抗菌药物 路径式管理 术后感染 

分 类 号：R969.3[医药卫生—药理学]