基于临床路径的公立医院住院患者抗菌药物使用规范性研究

目的分析2014年和2017年上海市3所公立医院社区获得性肺炎和胆囊结石合并急性胆囊炎的抗菌药物使用规范性。方法基于相关临床路径,对2014年和2017年社区获得性肺炎和胆囊结石合并急性胆囊炎2个病种的181份住院病例进行病案评阅,分析抗菌药物使用的规范性。结果社区获得性肺炎住院患者的抗菌药物使用规范性相对较高,而急性胆囊炎住院患者的抗菌药物使用规范性相对较低,尤其是我国临床路径推荐的第二代头孢菌素的使用患者数量仅占抗菌药物使用患者数量的4.80%。结论我国临床路径和诊疗指南的抗菌治疗推荐方案应及时更新,急性胆囊炎住院患者初始抗菌药物治疗的及时性和正确性有待提高。

Study on the Normativity of the Utilization of Antibiotics in Inpatients of Public Hospitals Based on Clinical Pathway

Objective To analyze the normativity of antibiotics’ utilization in inpatients with community-acquired pneumonia(pneumonia) and gallstones associated with acute cholecystitis and undergoing cholecystectomy(cholecystectomy) in 3 public hospitals of Shanghai City in 2017 and 2014. Methods Based on relevant Clinical Pathway,the normativity of antibiotics’ utilization was analyzed by auditing 181 medical records of the inpatients with pneumonia or cholecystectomy in 2017 and 2014. Results The normativity of antibiotics’ utilization in the inpatients with pneumonia was relatively high,while the normativity of antibiotics’ utilization in the inpatients with cholecystectomy was relatively low. Especially,the utilization of the second generation cephalosporins recommend in the national clinical pathway only accounted for 4.80% of total drugs. Conclusion The recommendations for antibiotic therapy in national Clinical Pathways and guidelines should be updated timely,and correct use of initial antibiotics in inpatients with cholecystectomy should be improved.