泌尿外科三、四级腹腔镜清洁手术患者术后预防使用抗菌药物的必要性分析  

Neccessity Analysis of Postoperative Prophylactic Application of Antibiotics in Patients Undergoing Third and Forth-level Laparoscopic Cleaning Surgery of Urinary Surgery Department

作　　者：张彦[1] 高杰[1] 陶婧 缪丽燕[1] ZHANG Yan;GAO Jie;TAO Jing;MIAO Liyan(Dept.of Pharmacy,the First Affiliated Hospital of Soochow University,Jiangsu Suzhou 215006,China)

机构地区：[1]苏州大学附属第一医院药学部,江苏苏州215006

出　　处：《中国药房》2018年第22期3138-3141,共4页China Pharmacy

基　　金：国家科技重大专项课题(No.2017ZX09304021);国家临床重点专科建设项目(No.国卫办医函[2018]292号)

摘　　要：目的:探讨泌尿外科三、四级腹腔镜清洁手术患者术后预防使用抗菌药物的必要性。方法:选择2016年1月-2017年12月我院泌尿外科住院治疗的264例接受三、四级腹腔镜清洁手术患者。将所有患者分别以预防用药时间是否超过24 h分为≤24 h组(40例)和>24 h组(224例),以术后预防使用抗菌药物种类分为未预防组(36例)、一代头孢组(102例)、头霉素组(93例)和三代头孢组(33例)。观察所有患者的术后发热及术后切口感染发生情况,不同组别患者的术后发热情况、术后住院时间及人均抗菌药物总费用。结果:264例患者中,术后发热≥38.0℃的有43例,其中有8例发热≥38.5℃;发热均发生在术后72 h内,其中术后24 h内发热的有34例,术后48 h内发热的有42例;持续发热2 d的有9例。另有1例患者发生术后切口感染。以预防用药时间是否超过24 h分的2组患者术后发热率、术后住院时间比较,差异均无统计学意义(P>0.05);≤24 h组患者人均抗菌药物总费用显著低于>24 h组(P<0.05)。以术后预防使用抗菌药物种类分的4组患者术后发热率、术后住院时间比较,差异均无统计学意义(P>0.05);一代头孢组、头霉素组、三代头孢组患者人均抗菌药物总费用均显著高于未预防组(P<0.05)。结论:我院泌尿外科三、四级腹腔镜清洁手术预防使用抗菌药物的问题较突出,主要表现为预防用药时间较长、术后换用较高级别抗菌药物不恰当,这不仅不会降低患者术后发热率、缩短术后住院时间,还会增加抗菌药物总费用。故建议对于泌尿外科三、四级腹腔镜清洁手术患者术后不需要预防使用抗菌药物。OBJECTIVE:To investigate the necessity of postoperative prophylactic application of antibiotics in patients undergoing third and forth-level laparoscopic cleaning surgery in urinary surgery department.METHODS:Totally 264 patients undergoing third and forth-level laparoscopic cleaning surgery were selected from urinary surgery department of our hospital during Jan.2016-Dec.2017.All patients were divided into≤24 h group(40 cases)and>24 h group(224 cases)according to whether the preventive medication time was more than 24 h.According to the types of antibiotics for postoperative use,those were divided into non-prevention group(36 cases),first-generation cephalosporin group(102 cases),cephalomycin group(93 cases)and third-generation cephalosporin group(33 cases).The postoperative fever and postoperative incision infection of all patients,postoperative fever,postoperative hospitalization time and total antibiotics cost per capita of different groups were all observed.RESULTS:Among 264 patients,there were 43 cases of postoperative fever≥38.0℃,among which there were 8 cases of postoperative fever≥38.5℃.The postoperative fever occurred within 72 h,among which 34 fever cases occurred within 24 h and 42 cases within 48 h.There were 9 cases of 2 d persistent fever.One case suffered from incision infection after operation.There was no statistical significance in the incidence of postoperative fever or postoperative hospitalization time between 2 groups which were grouped according to the time of prophylactic drug use more than 24 h or not(P>0.05).Total cost per capita of antibiotics in≤24 h group was significantly lower than>24 h group(P<0.05).There was no statistical significance in the incidence of postoperative fever or hospitalization time among 4 groups which were divided according to the type of antiboitics for prophylactic use(P>0.05).Total cost per capita of antibiotics in first-generation cephalosporin group,cephalomycin group and third-generation cephalosporin group were significantly higher than non-pr

关 键 词：预防使用 抗菌药物 泌尿外科 腹腔镜清洁手术 术后发热 住院时间 总费用 

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