骨科清洁手术预防使用抗菌药物与术后感染的关系

摘要

目的 探讨开展抗菌药物规范化管理对骨科术后感染率的影响.方法 统计分析该院2009年、2014年骨科Ⅰ类切口无植入物手术和闭合骨折切开复位内固定术围手术期抗菌药物使用情况及术后感染情况.结果 2009年和2014年上述Ⅰ类切口手术抗菌药物使用率分别为59.05%、26.25%,差异有统计学意义(P<0.05),而术后感染率差异无统计学意义(P>0.05).2009年和2014年闭合骨折切开复位内固定术术后使用抗菌药物的时间分别为2.45 d±0.37 d、1.55 d±0.44 d,差异有统计学意义(P<0.05),而术后感染率差异无统计学意义(P>0.05).2009年和2014年手术时间>2 h的患者抗菌药物使用率明显高于手术时间<2 h的患者(P<0.05),但术后感染率仍明显高于后者(P<0.05).结论 骨科Ⅰ类切口无植入内固定物手术和闭合骨折切开复位内固定术预防性使用抗菌药物并不会降低手术部位感染率;规范化的短程用药与长时间用药方案在预防手术部位感染的疗效上无明显差异;预防使用抗菌药物在Ⅰ类切口手术时要严格掌控适应证.%Objective To investigate the effect of standardized management of antibacterial drugs on the postoperative infection rate in department of orthopaedics.Methods The cases were retrospectively analyzed,which underwent the type Ⅰ incision surgery without implants and the closed fracture open reduction and internal fixation of the hospital in 2009,2014 year.The use of antimicrobial agents in perioperative period and postoperative infection were observed and calculated.Results In 2009 and 2014 year,the utilization rates of prophylactic antibiotics in the typeⅠ incision surgery that mentioned above were 59.05% and 26.25%,the difference of which was statistically significant (P<0.05),but there was no statistically significant difference in infection rate(P>0.05).In 2009 and 2014 year,the average treatment time of prophylactic antibiotics in the closed fracture open reduction and internal fixation were 2.45 d±0.37 d and 1.55 d±0.44 d,the difference of which was statistically significant (P<0.05),however,there was no statistically significant difference in infection rate (P>0.05).In these two years,the utilization rate of antimicrobial agents in the patients whose operation duration had continued more than 2 h was significantly higher than the rate of whose operation duration had not continued to 2 h(P<0.05),but the infection rate of the former was still significantly higher than that of the latter (P<0.05).Conclusions Using antibiotics prophylactically in the typeⅠ incision surgery without implants of orthopedics and the closed fracture open reduction and internal fixation will not reduce the infection rate of postoperation.And there is no significant difference in the curative effect of using drugs between standardized short course and long time in prevention of postoperative infection.The prophylactic use of antibiotics should be strictly controlled in regard to indication in the type Ⅰ incision surgery.