临床药师对清洁手术预防应用抗菌药物的干预研究

目的 评价分析某“三甲医院”清洁手术围手术期抗菌药物应用与干预措施实施的效果.方法 对干预前的2009-06-2010-05符合条件全部324例患者病历资料和干预后的2010-06-2011-05 420例清洁手术预防药抗菌药物情况进行对比分析.结果 干预前的324例患者全部使用了抗菌药物,预防用药率100％;0.5～2 h开始用药者 50例(15.4％),术前2～24 h开始用药者64例(19.8％),手术后开始用药者185例(64.8％),手术后平均预防用药时间为5.34 d;干预后420例手术中有198例(47.1％)未使用抗菌药物,术前0.5～2 h开始用药者28例(6.7％),手术后开始用药者22例(5.2％),手术后平均预防用药时间为1.44 d.干预后感染率与干预前无变化.结论 Ⅰ类切口手术预防性应用抗菌药物不合理现象在干预后有明显改善,但与卫生部要求I类清洁手术低于30％抗菌药物预防使用率仍有一定差距,亟待加强对外科医师规范化使用抗菌药物的管理和培训,以保证临床用药安全、有效和经济.

A study of the precautionary application of antibiotics in clean surgical operations by Clinical Pharmacist

Objective To evaluate and analysis the effect of the application and intervention of antibiotics in clean surgical operations during perioperative period in a top three hospital. Methods We extract discharged 324 cases before the intervention from June of 2009 to May of 2010 and 420 cases after the intervention from June of 2010 to May of 2011, then we analysis the situation about the precautionary application of antibiotics of all the clean surgical cases. Results We found antibiotics were used in 324 clean surgical cases before the intervention , use ratio is 100 % ; antibiotics were used in 50 cases （15.4% ） 0. 5-2 hours before operations; 64 cases （19.8 % ） were given antibiotics 2 -24 hours before operations. 185 cases（64.8%） received antibiotics after operations and average medication time after operations is 5.34days. We found 198 cases （47.1%） use no antibiotics among 420 cases after the intervention, antibiotics were used in 28 cases （6.7%） 0.5-2 hours before operations; 22 cases （5.2%） were given antibiotics after operations and average medication time after operations is 1.44 days, We found infection ratio have no difference before and after intervention. Conclusions We find great improvement in irrationnal phenomenons about the precautionary application of antibiotics in clean surgical operations （types of I incision） after the intervention, but we still have a gap in the use ratio （the requirement of Ministry of Health is〈30% ）of the precautionary application of antibiotics in clean surgical operations （types of I incision）. We need to strengthen management and training of standardized application of antibiotics in surgeons to ensure the application of antibiotics is safe, effective and economic.