神经外科Ⅰ类切口手术预防使用抗菌药物情况调查及术后颅内感染影响因素分析  

Investigation of antibiotics prophylaxis and influence factors of postoperative intracranial infection of a type I neurosurgical incision

作　　者：韩广信 王昌盛 HAN Guang-Xin;WANG Chang-sheng(The First Affiliated Hospital of Guangdong Pharmaceutical University,Guangzhou 510062,China)

机构地区：[1]广东药科大学附属第一医院,广州510062

出　　处：《中国处方药》2024年第9期46-49,共4页Journal of China Prescription Drug

摘　　要：目的调查某院神经外科Ⅰ类切口手术预防使用抗菌药物情况及分析术后颅内感染影响因素,为制订某院Ⅰ类切口手术预防使用抗菌药物管理制度,采取临床干预,实施监控措施提供依据。方法抽调2023年1月~5月在某院神经外科接受Ⅰ类切口手术患者的病例资料,共1276例,按统一方法及标准统计分析某院神经外科Ⅰ类切口手术预防用抗菌药物及术后颅内感染情况。结果1276例患者中,预防性使用抗菌药物的比例为96.6%(1232/1276);抗菌药物品种选择的合理率为51.1%(629/1232);给药时机的合理率为86.8%(1069/1232);术中应追加的合理率为23.4%(97/415);疗程≤24 h的比例为11.8%(145/1232);24 h<疗程≤48 h的比例为2.2%(27/1232);疗程>48 h的比例为86.0%(1060/1232);术后颅内感染发生率为2.1%(27/1276);细菌培养的阳性率为40.7%(11/27);单因素分析结果显示:手术时间>4 h,术中出血量>750 ml,颅内置引流管时间>72 h是术后颅内感染的高危因素。结论某院神经外科Ⅰ类切口手术抗菌药物使用存在预防用药比例高,品种选择合理率低、疗程长、给药时机及术中应追加的合理率低等问题。建议某院根据国家围术期抗菌药物管理规范,对神经外科Ⅰ类切口手术患者进行术后颅内感染风险预测及分层,探索有效、可行的管理模式,提高神经外科Ⅰ类切口手术抗菌药物的合理应用水平。Objective To investigate the use of antibiotics and postoperative intracranial infection in the perioperative period of a type I neurosurgical incision of a hospital.In order to improve the rational application level of antibiotics for perioperative prevention of type I incision,and provide basis for clinical intervention and monitoring in the hospital.Methods Extracted a total of 1276 cases of patients undergoing type I incision neurosurgical in a neurosurgery,statistical analysis of neurosurgical type I incision of antibiotics prophylaxis and postoperative intracranial infection were undergoing with the unified method and standard.Results Among the 1276 patients,the proportion of prophylactic antibiotics was 96.6%(1232/1276);the rational rate of antibiotics selection was 51.1%(629/1232);the reasonable timing of dosing was 86.8%(1069/1232);the reasonable rate of surgery which should be appended was 23.4%(97/415);the ratio of course of treatment which≤24 h was 11.8%(145/1232);the ratio of course of treatment which>24 h and≤48 h was 2.2%(27/1232);the ratio of course of treatment which>48 h was 86.0%(1060/1232);the incidence of postoperative intracranial infection was 2.1%(27/1276);the positive rate of bacterial culture was 40.7%(11/27);the results of single factor analysis showed:surgery time>4 h,intraoperative blood loss>750 ml,intracranial drainage tube time>72 h were high risk factors for postoperative intracranial infection.Conclusion The proportion of prophylactic antibiotics in the perioperative period of neurosurgical type I incision of the hospital was high,and a low rational rate of antibiotic selection,a long course of antibiotic use,and a low reasonable rate of timing of administration and antibiotics which should be appended.It is suggested that the hospital should establish a risk factor score scale to predict the risk of postoperative intracranial infection according to the national perioperative antibiotic management rules,explore an effective and feasible management model,and improve the ration

关 键 词：神经外科 Ⅰ类切口 抗菌药物 颅内感染 影响因素 

分 类 号：R969.3[医药卫生—药理学]