日间手术患者抗菌药物应用回顾性研究  

A retrospective study on the application of antimicrobial agents in patients undergoing day surgery

作　　者：黄晓萱 谢新秀 刘蔚东[2] 莫洋[1,2] HUANG Xiaoxuan;XIE Xinxiu;LIU Weidong;MO Yang(Teaching and Research Section of Clinical Nursing,Xiangya Hospital,Central South University,Changsha,Hunan 410008,P.R.China;Day Surgery Center,Xiangya Hospital,Central South University,Changsha,Hunan 410008,P.R.China)

机构地区：[1]中南大学湘雅医院临床护理教研室,长沙410008 [2]中南大学湘雅医院日间手术中心,长沙410008

出　　处：《华西医学》2021年第2期205-210,共6页West China Medical Journal

摘　　要：目的分析日间手术患者抗菌药物使用情况,以指导日间手术抗菌药物的合理使用。方法回顾性收集、分析中南大学湘雅医院日间手术中心2016年6月-2017年9月进行日间手术患者的住院资料与回访资料,统计分析其抗菌药物使用情况,探究日间手术抗菌药物使用是否存在不合理现象,并分析其原因。结果最终纳入研究的手术共4054台次,其中使用抗菌药物的患者1293例,日间手术抗菌药物使用率达31.89%。使用抗菌药物的患者中清洁手术、清洁-污染手术、污染手术与污秽-感染手术所占百分比分别为12.22%、65.20%、7.27%与15.31%。清洁手术患者是否应用抗菌药物对切口转归无影响(P=0.073)。患者所用抗菌药物种类中最多的为头孢菌素类(57.50%),以单药使用为主(97.91%),多为患者在家中自行口服用药;抗菌药物来源多为患者出院后自行购药(65.43%);抗菌药物使用最多的专科分别为口腔科(23.98%)、耳鼻咽喉科(22.58%)与妇产科(22.51%);平均用药时间为(5.37±1.86)d;预防性使用抗菌药物后仍有7.42%的患者发生手术部位感染,其中以普外科最多。结论日间手术患者中抗菌药物使用存在的不合理现象包括:清洁-污染手术预防性用药比例较高,初始用药级别较高,多为患者在自家口服用药,缺乏指导,用药时间过长等,迫切需要对日间手术患者的抗菌药物使用进行科学指导。Objective To analyze the current situation of antimicrobial agents using in day surgery patients to guide the rational use of antimicrobial agents in day surgery.Methods The day surgery performed in Day Surgery Center of Xiangya Hospital of Central South University from June 2016 to September 2017 was selected.We retrospectively collected and analyzed patients’hospitalization data and return visit data,statistically analyzed their use of antimicrobial agents,explored whether there was an unreasonable phenomenon in the use of antimicrobial agents,and analyzed the reasons.Results There were 4054 surgeries included in this study,and 1293 patients using antimicrobial agents,the use rate of antimicrobial agents in day surgery patients reached 31.89%.Aseptic,cleancontaminated,contaminated and dirty surgery accounted for 12.22%,65.20%,7.27%,and 15.31%separately.Whether the application of antimicrobial agents in aseptic surgery patients had no effect on the outcome of the incision(P=0.073).The most common type of antimicrobial agents used by patients are cephalosporins(57.50%),mainly used as single drugs(97.91%)and mostly oral used in patients’home.Most of the sources of antimicrobial agents were purchased by patients after they were discharged from the hospital(65.43%).The antimicrobial agents more used by Stemmatological Department(23.98%),Ear/Nose/Throat Department(22.58%)and Obstetrics and Gynecology Department(22.51%).The average used time of antimicrobial agents was(5.37±1.86)days,and 7.42%of patients still had surgical site infections after the use of prophylactic antimicrobial agents,most of them from General Surgery Department.Conclusions The unreasonable phenomena in the use of antimicrobial agents in patients with day surgery include:a high proportion of preventive medications for clean-contamination surgery,a high level of initial medication,and most patients take oral medications at home and lack of guidance,and long medication time.There is an urgent need for scientific guidance on the use of antimicro

关 键 词：日间手术 抗菌药物 合理用药 手术部位感染 

分 类 号：R95[医药卫生—药学]