Ⅰ类切口手术围术期预防性使用抗菌药物的干预效果研究

摘要

目的:调查川北医学院附属医院临床药师对Ⅰ类切口手术围术期预防性应用抗菌药物的干预情况,以期为临床合理用药提供参考.方法:分别选取2014年1-12月出院的997例(干预前组)和2016年1-12月出院的958例(干预后组)Ⅰ类切口手术患者,对其围术期预防性应用抗菌药物的情况进行统计,并对干预措施实施前后情况进行比较分析.结果:通过临床药师干预,Ⅰ类切口手术围术期患者预防性应用抗菌药物的使用率干预后较干预前下降了9. 87％;药物品种选择方面,干预后组预防性使用1、2代头孢菌素者比例明显高于干预前组(81. 46％ vs. 62. 12％,P ＜ 0. 01);用药时机及疗程方面,干预后组术前0. 5 ～ 1 h预防性应用抗菌药物以及术后用药疗程≤24 h的比例均明显高于干预前组(96. 15％ vs. 85. 10％,P＜0. 01; 68. 18％vs. 29. 55％,P ＜ 0. 01);适应证方面,干预后组的合理性用药比例也明显高于干预前组(84. 62％ vs. 73. 67％,P ＜ 0. 01);另外,在用法用量、药物联用等方面干预后较干预前均得到明显改善.结论:临床药师对围术期预防性应用抗菌药物进行干预能提高抗菌药物的合理使用,对促进临床安全、有效地应用抗菌药物起到了良好的效果.%Objective: To investigate the intervention effect of prophylactic application of antibiotics for Type Ⅰ incision surgery in perioperative period in order to provide references for the rational drug use in clinic. Methods: 997 cases of Type Ⅰ incision surgery patients (before-intervention) discharged from January to December 2014 and 958 cases of Type Ⅰ incision surgery patients (after intervention) discharged from January to December in 2016 were selected to analyze statistically the prophylactic application of antibiotics in the perioperative period. Comparison and analysis were made on the situations before and after the intervention measures were taken. Results: The prophylactic use rate of antibiotics for Type Ⅰ incision surgery in perioperative period after the intervention of the clinical pharmacists decreased by 9. 87％, compared with that before intervention. As far as the selection of drugs was concerned, the proportion of prophylactic use of first and second generations of cephalosporins in the intervention group was significantly higher than that in the pre-intervention group (81. 46％ vs. 62. 12％, P ＜ 0. 01). As for the medication timing and course of treatment, both the proportion of prophylactic application of antibiotics 0. 5-1 hour before surgery and the proportion of course of treatment no more than 24 hours of the intervention group were significantly higher than those of the pre-intervention group (96. 15％ vs. 85. 10％, P ＜ 0. 01; 68. 18％ vs. 29. 55％, P ＜ 0. 01). As far as the adaptations were concerned, the rational drug use rate of the intervention group was also significantly higher than that of the pre-intervention group (84. 62％ vs. 73. 67％, P ＜ 0. 01). Furthermore, dosages, drug combined uses and other aspects were significantly improved through intervention. Conclusion: The intervention of the clinical pharmacists to prophylactic application of antibiotics in perioperative period will improve the rational application of antibiotics and promote the safe and effective use of antibiotics in clinic.