骨科临床路径实施对抗菌药物合理使用的影响

摘要

Objective To analyze the effect of clinical pathway (CP) on antimicrobial prophylaxis in patients with total hip arthroplasty in department of orthopaedics. Methods Clinical data of 196 patients with total hip arthroplasty for femoral neck fracture from June of 2012 to December of 2013 in Central Hospital of Baoji City were retrospectively an-alyzed. 98 patients without implementing CP were as non-CP group and 98 patients with CP were as CP group. The prevention use of antibiotics in two groups during perioperative period were analyzed and evaluated. Results The use of antimicrobial drugs in the CP group was more rational than the non-CP group, the rate of using antibiotics were 100.00%in CP group and 56.12%in non-CP group, and the rate of reasonable initial medication timing were 100.00%in CP group and 77.55%in non-CP group, the duration of prophylactic treatment were (3.94±1.31) d and (11.72±7.59) d, the average hospitalization period were (17.52±1.5) d and (23.32±3.44) d, the average cost of antibacterial agents were (624.18±435.42) yuan and (2099.87±1290.32) yuan, the average cost of drugs were (5148.78±1129.63) yuan and (7156.48±1680.66) yuan and the total cost were (49 667.87±10 171.90) yuan and (58 160.02±14 021.89) yuan, the dif-ferences between two groups were significantly (P<0.05 or P<0.01). Conclusion The implementation of CP can ra-tionalize preventive peri-operative antimicrobial using in total hip arthroplasty, shorten the hospitalization period, and reduce the cost of hospitalization.%目的：调查分析临床路径对骨科髋关节置换术患者围术期预防应用抗菌药物的影响。方法回顾性分析2012年6月~2013年12月陕西省宝鸡市中心医院股骨颈骨折的全髋关节置换术196例患者的临床资料，将实施临床路径的98例设为实施临床路径组(CP组)，未实施临床路径的98例设为非临床路径组(非CP组)。分析和评估两组患者围术期预防使用抗菌药物情况。结果 CP组较非CP组抗菌药物使用更为合理，两组药物选择合理率分别为100.00%和56.12%，给药时机合理率分别为100.00%和77.55%，用药疗程分别为(3.94±1.31)、(11.72±7.59)d；CP组与非CP组的人均住院日分别为(17.52±1.50)、(23.32±3.44)d，人均抗菌药物费用分别为(624.18±435.42)、(2099.87±1290.32)元，人均药品费用分别为(5148.78±1129.63)、(7156.48±1680.66)元，人均住院总费用分别为(49667.87±10171.90)、(58160.02±14021.89)元，两组比较差异均有统计学意义(P<0.05或P<0.01)。结论临床路径的实施使髋关节置换术围术期预防性使用抗菌药物趋于合理，缩短了住院时间，减少了患者住院费用。