骨科Ⅰ类切口手术预防使用抗菌药物评价标准的建立与带量采购前后合理性、经济性评价应用  

Establishing evaluation standards for the preventive use of antimicrobial drugs in classⅠincision orthopedic surgery and evaluating rationality and cost-effectiveness before and after volume-based procurement

作　　者：汪江涛 杨礼跃 宋俊兴[1] 孙青松 叶鸣 方佳 后萍 丁伯平 WANG Jiangtao;YANG Liyue;SONG Junxing;SUN Qingsong;YE Ming;FANG Jia;HOU Ping;DING Boping(Affiliated Hospital of Anhui College of Traditional Chinese Medicine,Wuhu 241003,China;Wuhu Food and Drug Inspection Center,Wuhu 241007,China;School of Pharmacy,Wannan Medical College,Wuhu 241002,China)

机构地区：[1]安徽中医药高等专科学校附属医院<芜湖市中医医院>,安徽芜湖241003 [2]芜湖市食品药品检验中心,安徽芜湖241007 [3]皖南医学院药学院,安徽芜湖241002

出　　处：《药学研究》2025年第1期89-93,104,共6页Journal of Pharmaceutical Research

基　　金：安徽省教育厅自然科学研究重点项目(No.2023AH053202)。

摘　　要：目的建立骨科Ⅰ类切口手术预防使用抗菌药物评价标准,评价药品带量采购对该类手术合理性、经济性的影响。方法以《抗菌药物临床用指导原则(2015版)》、相关药品说明书、临床指南及专家共识等为依据制定评价标准。以2021年10月抗菌药物带量采购为政策执行点,选取安徽省某三甲医院2019年5月—2024年2月的9个骨科270份(带量采购前135份,带量采购后135份)Ⅰ类切口手术归档病例采用加权TOPSIS法进行数据分析。结果评价指标权重占比较高的有适应证、药品选择、术前、术中、术后给药时机、遴选药物经济性(分别为0.181、0.170、0.144、0.076、0.072、0.066)。政策执行后平均病例抗菌药物使用费用降幅为77.67%,带量采购前用药合理占70.37%(C_(i)≥0.6),带量采购后用药合理占84.45%(C_(i)≥0.6),差异具有统计学意义(P<0.05)。结论应用加权TOPSIS法评价骨科Ⅰ类切口手术预防使用抗菌药物合理性、经济性的方法可行,带量采购减轻患者用药负担的同时间接提高了用药的合理性,针对存在不合理现象医院需加强监管,促进临床合理用药。Objective To establish evaluation criteria for the prophylactic use of antimicrobial drugs in ClassⅠincision orthopedic surgeries and to assess the impact of volume-based procurement on the rationality and cost-effectiveness of such surgeries.Methods Evaluation criteria were developed based on the Guidelines for Clinical Use of Antimicrobial Agents(2015 Edition),drug information leaflets,clinical guidelines,and expert consensus.Using the implementation of volume-based procurement of antimicrobials in October 2021 as a reference point,data from 270 archived cases of ClassⅠincision orthopedic surgeries at a tertiary hospital in Anhui Province,spanning May 2019 to February 2024,were analyzed.These cases included 135 surgeries each from periods before and after the implementation of the procurement policy,and data were analyzed using the weighted TOPSIS(Technique for Order Preference by Similarity to Ideal Solution)method.Results The indicators with the highest weighting were appropriateness of indication,drug selection,timing of administration(preoperative,intraoperative,postoperative),and cost-effectiveness of selected drugs,with respective weights of 0.181,0.170,0.144,0.076,0.072,and 0.066.Post-policy implementation,the average cost of antimicrobials per case decreased by 77.67%.Rational drug use increased significantly from 70.37%(C_(i)≥0.6)before to 84.45%(C_(i)≥0.6)after volume-based procurement,with statistical significance(P<0.05).Conclusion The weighted TOPSIS method is a feasible approach for evaluating the rationality and cost-effectiveness of prophylactic antimicrobial use in classⅠincision orthopedic surgeries.Volume-based procurement not only reduces patient medication costs but also indirectly improves the rationality of drug use.Hospitals should strengthen oversight of irrational drug use to promote rational clinical prescribing practices.

关 键 词：药品带量采购 抗菌药物 骨科Ⅰ类切口手术 加权TOPSIS法 

分 类 号：R978[医药卫生—药品]