骨科围术期预防性使用抗菌药物情况分析

目的：了解2008年我院骨科围术期预防性应用抗菌药物的情况,并评价其用药合理性。方法：利用我院＂军卫一号系统＂查阅2008年1～12月骨科围手术期的3 229份病历,对其中预防性应用抗菌药物的品种、联合用药、用药疗程、用药时机和手术类型等进行统计分析。结果：我院骨科围手术期患者的抗菌药物总使用率为96.72%（3 123例）;手术类型Ⅰ类切口2 468例（76.43%）、Ⅱ类切口404例（12.51%）、Ⅲ类切口357例（11.06%）;预防性应用抗菌药物开始时机：术前2 h内给药的444例,占14.28%,术后1～3 h给药2 426例,占78.03%,术后预防性持续用药时间3天内有964例（31.00%）,3～7天1 719例（57.61%）。抗菌药物用药方式：单用、二联和三联分别为2 861例（91.61%）、260例（8.33%）和2例（0.06%）;以单用为主,主要品种为头孢菌素（77.91%）、氟喹诺酮类（14.61%）及其他（7.48%）。结论：骨外科围术期抗菌药物的预防性应用基本合理,但用药种类较多,用药时间较长,需加强对抗菌药物的应用管理,按规范要求使用,提高合理用药水平。

Perioperative Preventive Use of Antibiotics in Orthopedic Patients

OBJECTIVE ： To investigate the status quo and rationality of the perioperative use of antibiotics in orthopedic patients of our hospital. METHODS： A total of 3 229 perioperative medical records of orthopedic patients retrieved by Army No. 1 System between Jan. and Dec. in 2008 were analyzed statistically in respect of the category of antibiotics, combined use of antibiotics, courses of treatment, application time and surgery types etc. RESULTS： 96.72% （3 123 patients） received antibiotics perioperatively. 76.43 % （2 468） patients had type Ⅰ incision, 12.51% （404） type Ⅱand 11.06 % （357） type Ⅲ. 444 （14.28%） received antibiotics 2h prior surgery and 2 425 （78.03%） within 1 to 3 hours postoperatively; 964 （31.00%） received antibiotics for 3 consecutive days and 1 719 （57.61%） for 3 to 7 days. 2 861 （91.61%） received one kind of antibiotics, and 260 （8.33%） received two kinds and 2 （0.06%） three kinds of antibiotics in combination. The main categories administered were cephalosporins （77.91% ）, quinolones （ 14.61% ） and others （7.48%）. CONCLUSION： The preventive use of antibiotics in orthopedic patients is rational on the whole. But the category and of antibiotics applied is on the high side and the medication duration of which is long. It is urgent to tighten control on the management in the application of antibiotics to ensure standard use of antibiotics and improve the level of rational use of antibiotics.