Ⅰ类切口手术患儿抗菌药物使用分析

摘要

目的 分析Ⅰ类切口手术患儿抗菌药物使用情况,探讨抗菌药物使用的合理性.方法 收集2010年1月至2013年6月在新疆维吾尔自治区人民医院接受睾丸固定术、手术血管瘤切除术、腹外疝手术、闭合性骨折、体表包块切除术等Ⅰ类切口手术的642例患儿的出院病历,就抗菌药物使用情况进行回顾性分析,其中2010年157例,2011年157例,2012年181例,2013年1-6月147例.结果 2010、2011、2012年和2013年1-6月,抗菌药物用药评价合理率分别为13.4％(21/157)、4.5％(7/157)、66.9％(121/181)、85.7％(126/147);抗菌药物选择不合理百分率分别为42.0％ (66/157)、56.7％(89/157)、18.8％(34/181)、0.0％(0/147);无指征应用抗菌药物百分率分别为12.1％ (19/157)、29.3％ (46/157)、1.7％(3/181)、0.0％(0/147);给药时机不合理百分率分别为59.2％ (93/157)、62.4％(98/157)、18.1％(33/181)、13.0％(19/147);术后给药时间＞48 h百分率分别为58.0％(91/157)、54.8％(86/157)、15.5％(28/181)、4.8％(7/147);用法用量不合理百分率分别为22.3％(35/157)、5.7％ (9/157)、6.1％ (11/181)、1.4％(2/147).使用频次居前3位的抗菌药物2010年分别为头孢硫脒、头孢西丁钠、盐酸头孢替安;2011年分别为盐酸头孢替安、头孢硫脒、头孢西丁钠;2012年分别为头孢孟多酸钠、盐酸头孢替安、头孢西丁钠;2013年1－6月分别为头孢呋辛钠、头孢拉定、头孢曲松钠.2010、2011、2012年,联合使用抗菌药物百分率分别为5.7％(9/157)、14.6％(23/157)、5.5％ (10/181);2013年1－6月未见联合用药.结论 本院儿童Ⅰ类切口手术抗菌药物使用合理率逐年提高,但给药时机不合理、术后用药时间长等问题仍然存在.%Objective To analyze the use of antibiotics in children with type Ⅰ incision operation.Methods Six hundred and forty-two medical records of children with type Ⅰ incision operation,including orcheopexy,resection of hemangioma,abdominal external hernia operation,closed fracture operation and body mass excision from January 2010 to June 2013 were collected and the use of antibiotics were retrospectively analyzed.There were 157 cases in 2010,157 cases in 2011,181 cases in 2012 and 147 cases from January to June 2013.Results In 2010,2011,2012 and from January to June in 2013,the rational use of antibiotics was 13.4％ (21 / 157),4.5％ (7/157),66.9％ (121/181) and 85.7％ (126/147),respectively;the ratio of improper antibiotics selection was 42.0％ (66/157),56.7％ (89/157),18.8％ (34/181)and0.0％ (0/147),respectively;the ratio of application without indications was 12.1％ (19/157),29.3％ (46/157),1.7％ (3/181) and 0.0％ (0/147),respectively;the ratio of improper administration time was 59.2％ (93/157),62.4％ (98/157),18.1％ (33/181) and 13.0％ (19/147),respectively;the ratio of postoperative administration time ＞48 h was 58.0％ (91/157),54.8％ (86/157),15.5％ (28/181) and 4.8％ (7/147),respectively;the ratio of unreasonable usage and dosage was 22.3％ (35/157),5.7％ (9/157),6.1％ (11/181) and 1.4％ (2/147),respectively.For the use frequency,the first three antibiotics were cefathiamidine,cefoxitin sodium and cefotiam in 2010,cefotiam,cefathiamidine and cefoxitin sodium in 2011,cefamandole,cefotiam and cefoxitin sodium in 2012,cefuroxime sodium,cefradine and cefiriaxone sodium from January to June in 2013.In 2010,2011,2012,the ratio of combined use of the antibacterial drugs was 5.7％ (9/157),14.6％ (23/157) and 5.5％ (10/181),respectively;from January to June in 2013,there was no combined use of the antibacterial drugs.Conclusion The rational application of antibiotics in children of type Ⅰ incision operation has been improved year by year,while improper administration time and long-time of postoperative administration are still existed.