PDCA循环对腹腔镜下胆囊切除术围手术期预防使用抗菌药物的影响效果分析  

Effect analysis of PDCA cycle on prophylactic use of antibiotics in laparoscopic cholecystectomy during perioperative period

作　　者：张晶晶 王凤玲[1] 孟祥云[1] 苏丹 ZHANG Jingjing;WANG Fengling;MENG Xiangyun;SU Dan(Dept.of Pharmacy,Hefei Second People’s Hospital/the Affiliated Hefei Hospital of Anhui Medical University,Hefei 230011,China;Health Management Center,the First Affiliated Hospital of University of Science and Technology of China(Anhui Provincial Hospital),Hefei 230001,China)

机构地区：[1]合肥市第二人民医院/安徽医科大学附属合肥医院药学部,合肥230011 [2]中国科学技术大学附属第一医院(安徽省立医院)健康管理中心,合肥230001

出　　处：《中国药房》2023年第13期1632-1636,共5页China Pharmacy

基　　金：国家自然科学青年科学基金资助项目(No.82003849);中国药学会医院药学专委会医院药学科研专项(No.CPAZ05-ZC-2021-002);合肥市第二人民医院院级光华基金立项科研项目(No.院科教[2019]171号-7)。

摘　　要：目的评价PDCA循环在腹腔镜下胆囊切除术围手术期预防使用抗菌药物发挥的作用并进行药物经济学分析。方法采用回顾性分析方法,随机抽取合肥市第二人民医院根据发生不合理用药的真正或根本原因采取PDCA循环干预前(2019年5-6月)、第1轮PDCA循环干预后(2020年5-6月)、第2轮PDCA循环干预后(2021年5-6月)进行腹腔镜下胆囊切除术的出院患者各80例,对患者进行预防使用抗菌药物的合理性进行点评。对比干预前及第1、2轮PDCA循环干预后患者的一般情况、抗菌药物使用情况、临床疗效、治疗成本,并采用成本-效果分析法及敏感度分析法评价PDCA循环的药物经济学意义。结果第2轮PDCA循环干预后,抗菌药物使用不合理率、抗菌药物金额占比、抗菌药物使用天数、用药频度、药物利用指数、人均抗菌药物使用频次、抗菌药物总用量、抗菌药物费用、药品总金额、住院总费用较干预前均显著下降/减少(P<0.05)。成本-效果分析结果提示,第2轮PDCA循环干预后的药物经济学效果最佳;敏感度分析结果趋势一致,证实研究结果可靠。结论PDCA循环促进了腹腔镜下胆囊切除术围手术期预防使用抗菌药物的合理应用,降低了抗菌药物费用,减轻了患者就医的经济负担。OBJECTIVE To evaluate the effect of PDCA cycle on prophylactic use of antibiotics in laparoscopic cholecystectomy during perioperative period and to conduct pharmacoeconomic analysis.METHODS Using retrospective analysis method,80 discharged patients of each group underwent laparoscopic cholecystectomy were randomly selected from Hefei Second People’s Hospital before PDCA cycle(from May to June 2019),after the first round of PDCA cycle(from May to June 2020),after the second round of PDCA cycle(from May to June 2021)according to real or basic reasons for irrational drug use.The rationality of prophylactic use of antibiotics for patients was evaluated.The general situation,antibiotic use,clinical efficacy and treatment cost of patients were compared before cycle and after the first and second rounds of PDCA cycle.Cost-effectiveness analysis method and sensitivity analysis method were adopted to evaluate pharmacoeconomic significance of PDCA cycle.RESULTS After two rounds of PDCA cycle,the irrational rate of antibiotics,cost ratio of antibiotics,the number of days of antibiotics use,DDDs,drug utilization index,the frequency of antibiotics use per capita,the total amount of antibiotics,the cost of antibiotics,the total amount of drugs,and the total cost of hospitalization all decreased significantly(P<0.05).The results of cost-effectiveness analysis indicated that the pharmacoeconomic effect was the best after two rounds of PDCA cycle;the results of sensitivity analysis were consistent with it,which confirmed the reliability of the research results.CONCLUSIONS PDCA cycle promotes the rational use of antibiotics of laparoscopic cholecystectomy during perioperative period,reduces the cost of antibiotics and relieves the economic burden of patients.

关 键 词：PDCA循环 腹腔镜下胆囊切除术 围手术期 抗菌药物 成本-效果分析 敏感度分析 

分 类 号：R969.3[医药卫生—药理学] R956[医药卫生—药学]