甲状腺手术抗菌药物使用调查与分析

目的调查某院甲状腺手术患者预防性应用抗菌药物现状。方法抽取2004年1-12月出院的所有甲状腺手术患者病历，剔除不符合要求病历后，对剩余265份病历分别填写围手术期抗菌药物个案调查表，并对数据进行统计分析。结果265例甲状腺手术患者均预防性应用抗菌药物，其中有指征者113例（42．64％），无指征者152例（57．36％）。所用抗菌药物涉及5大类12个品种，以林可霉素类、头孢菌素类、青霉素类、喹诺酮类为主。不合理用药表现为选药不当（58．49％）；给药次数不当（4．91％）；剂量过大（4．15％）；围手术期用药：未在术前30min-2h给药者占88．30％，5例手术时间〉4h者术中均未追加抗菌药物，术后无感染征象或无高危易感因素而给药时间〉48h未停药者占50．19％。结论该院甲状腺手术预防用抗菌药物尚存在不合理现象，应加强培训和管理，督促临床医生合理应用抗菌药物。

Investigation and analysis on the application of antimicrobial agents in patients with thyroidectomy

Objective To investigate the application of antimicrobial agents in patients with thyroidectomy in a hospital.Methods All medical records of patients with thyroidectomy who were discharged from January to December 2004 were reviewed,investigation forms of the peri-operative application of antimicrobial agents in 265 patients were filled out and analysed.Results All the 265 cases received prophylactic antimicrobial agents,113(42.64%) of whom had indications,152(57.36%) were without indications,the main used antimicrobial agents were lincomycins,cephalosporins,penicillins and quinolones.58.49% of patients had inappropriate choice of antimicrobial agents,4.91% had inappropriate frequency of antimicrobial agents,4.15% received high dosage of antimicrobial agents;88.30% of patients did not receive antimicrobial agents 30 minutes ~2 hours before operations,5 cases whose operation time >4 hours were not added antimicrobial agents during the operations,50.19% of patients who were without indications of infections or risk factors after operations did not stop antimicrobial agents after they had received antimicrobial agents for more than 48 hours.Conclusion There are irrational phenomena in the prophylactic application of antimicrobial agents in patients with thyroidectomy in this hospital,the management and education about rational use of antimicrobial agents must be strengthened among clinical doctors.