Ⅰ类切口围手术期预防性使用抗菌药物调查分析

目的：了解我院Ⅰ类切口围手术期预防性使用抗菌药物情况,为医院管理部门制订相应管理措施提供科学依据。方法：采用回顾性调查方法,随机抽样我院2008年7月至2009年6月出院的562例Ⅰ类切口患者预防使用抗菌药物情况。结果：562例患者全部预防性使用了抗菌药物,抗菌药物使用率100%。使用抗菌药物种类前三名依次为：头孢菌素三代257例次,占31.38%;头孢菌素二代160例次,占19.54%;青霉素类149例次,占18.19%。术后用药时间≤48小时23例,占4.09%;用药3-5天132例,占23.49%;用药5-7天177例,占31.50%;用药大于7天230例,占40.92%。首剂抗菌药物给药时机：术前0.5-2h给药494例,占87.90%;术后返回病房给药68例,占12.10%。手术时间〉3h患者172例,其中术中追加第二剂抗菌药物74例,占43.02%;未追加第二剂抗菌药物98例,占56.98%。联合用药情况：单联用药435例,占77.40%;2联用药120例,占21.35%;3联用药7例,占1.25%。结论：Ⅰ类切口手术预防性使用抗菌药物存在不合理性：预防性使用抗菌药物指征把握不严,使用率高;抗菌药物种类选择不合理;术后用抗菌药物时间过长;部分患者首剂用药时机不当;有不合理的联合用药及过度用药问题。提示今后应进一步加强围手术期预防使用抗菌药物的监督和管理。

Investigation and analysis on type I incision perioperative antibiotic prophylaxis

Objectives：To understand type Ⅰ incision Perioperative antibiotic prophylaxis in selected hospital and to provide a scientific evidence for relevant policy making. Methods：562 cases with type Ⅰ incision of in patients were retrospectively investigated about antibiotic prophylaxis status by random sampling from the discharged patients of selected hospital from July 2008 to June 2009. Results：562 cases of patients all used antibiotic prophylaxis and antimicrobial drug usage was 100%. The top three antibiotics were respectively third-generation cephalosporins,which included 257 cases,accounting for 31.38%,second-generation cephalosporins,which included 160 cases,accounting for 19.54% and Penicillin 149 cases,accounting for 18.19%. 23 cases among them were given antibiotic prophylaxis within 48 hours after operation,which accounting for 4.09%,132 cases were given antibiotic prophylaxis for 3-5 days after operation,accounting for 23.49%,177 cases for 5-7 days,accounting for 31.50%,230 cases for more than 7 days,accounting for 40.92%. Timing of the first dose of antibiotics administered：0.5-2h before operation occupying 494 cases,accounting for 87.90%,back to the wards after operation occupying 68 cases,accounting for 12.10%. Among 172 operation time over 3h patients,74 cases were given the second dose of antibiotics,accounting for 43.02%. The second dose of antibiotics was not administered for 98 cases,accounting for 56.98%. Combination therapy was respectively 435 cases of single medication,accounting for 77.40%,combination of 2 drugs 120 cases,accounting for 21.35%,3 medication in 7 cases,accounting for 1.25%. Conclusions：Irrational antibiotic prophylaxis in type Ⅰ incision Perioperative is exist. The antibiotic prophylaxis rate is high and is not according to strict indications. Selection of antibiotics types is unreasonable. The time of using antibiotics after operation is too long. The first dose of medication in some patients is not the right time. There are unreasonable co-medication and over-medication problems. It is suggested that antibiotic prophylaxis in type Ⅰ incision Perioperative should be further strengthened to supervise and management.