骨科Ⅰ类切口手术抗菌药物预防使用情况分析  

Prophylactic Usage of Antibiotics in Orthopedic TypeⅠIncision Surgery

作　　者：李岩 杨海青 易海龙 王宇龙 朱立强 LI Yan;YANG Hai-qing;YI Hai-long;WANG Yu-long;ZHU Li-qiang(Air Force Hospital,the Central Theater Command,Datong 037000,China)

机构地区：[1]中部战区空军医院,山西大同037000

出　　处：《解放军药学学报》2024年第4期314-317,共4页Pharmaceutical Journal of Chinese People's Liberation Army

基　　金：中部战区空军医院科研项目,No.2022-04。

摘　　要：目的了解骨科Ⅰ类切口手术抗菌药物预防使用的情况,评价骨科Ⅰ类切口手术抗菌药物预防使用的合理性,为手术抗菌药物合理使用提供参考。方法通过某医院感染实时监控系统提取2022年1月-2023年10月骨科住院患者中行Ⅰ类切口手术的患者1927例,进行回顾性调查研究,分析其预防用药的合理性,并采用帕累托分析法分析不合理用药类型的主要因素、次要因素及一般因素。结果1927例Ⅰ类切口手术有1356例预防性用药,预防使用率为70.37%;其中589例患者在术前0.5~1 h给予抗菌药物,占43.44%,546例预防用药疗程不超过24 h,占40.26%;预防用药占比前2位的是头孢呋辛(89.01%)和左氧氟沙星(8.26%);812例存在预防用药不合理的问题,不合理用药率为59.88%。帕累托分析结果显示,影响不合理用药类型的主要因素有疗程不适宜和预防用药给药时机不合理,分别为810例次(40.76%)和767例次(38.60%);次要因素为无指征预防用药202例次(10.17%);一般因素有预防用药品种选择不当、手术时间>3 h未追加用药和不合理联合用药,分别为137例次(6.89%)、56例次(2.82%)和15例次(0.75%)。结论该院骨科Ⅰ类手术围手术期预防用抗菌药物存在预防用药疗程不适宜、给药时机不合理、无指征预防用药等情况,应采取相应措施加强抗菌药物监督管理,促进抗菌药物合理使用。Objective To find out about the prophylactic usage of antibiotics in patients undergoing orthopedic typeⅠincision surgery,evaluate the rationality,and provide references for rational use of antibiotics in surgery.Methods A total of 1927 cases of orthopedic inpatients who had undergone type I incision surgery between January 2022 and October 2023 were selected by the military hospital infection real-time monitoring system.The rationality of preventive medications was analyzed,and the Pareto analysis method was used to analyze the primary,secondary,and minor manifestations of irrational medications.Results There were 1356 cases of prophylactic drug use in 1927 cases of typeⅠincision surgery,and the rate of prophylactic use was 70.37%.It was found that 589 of these patients were given antibiotics 0.5-1 hour preoperatively,accounting for 43.44%,while 546 were given prophylactic medications for less than 24 h,accounting for 40.26%.Cefuroxime(89.01%)and levofloxacin(8.26%)were the top two preventive drugs used.Irrational use of preventive drugs was found in 812 cases,and the rate of irrational use of drugs was 59.88%.The results of Pareto analysis showed that irrational drug use mostly involved inappropriate courses of treatment and irrational timing of preventive medications,with 810 cases(40.76%)and 767 cases(38.60%)respectively.The second most common flaws were the use of preventive medications without indications(202 cases,10.17%).Minor flaws included improper selection of preventive medications,no additional medication for surgeries that lasted more than 3 h and imperfect combination of medications,which were 137 cases(6.89%),56 cases(2.82%)and 15 cases(0.75%)respectively.Conclusion The perioperative prophylactic use of antibiotics in orthopedic type I incision has some flaws,such as inappropriate courses of prophylactic medications,improper timing of administration,and no indications of prophylactic medication.Corresponding measures should be taken to strengthen the supervision of antibiotics and promote the

关 键 词：骨科手术 Ⅰ类切口 抗生素 

分 类 号：R969[医药卫生—药理学]