综合运用干预措施对围术期预防应用抗菌药物的影响评价

目的通过综合运用多种干预措施对围术期预防应用抗菌药物的影响评价,为规范医院抗菌药物预防性应用、探索合理干预措施管理提供依据。方法分别随机抽取2009年度和2010年度出院患者的手术病历各220份,分别作为干预前组和干预后组,调查分析干预前后围术期预防性使用抗菌药情况。结果干预后术前〉2h应用抗菌药的比例由18.2%减少到3.2%（P〈0.05）,术前0.5～2h应用抗菌药比例由3.6%提高42%（P〈0.05）。术后,开始应用抗菌药比例由78.2%降到54.3%（P〈0.05）,抗菌药平均应用时间由8.5d减少到5.6d;平均住院天数由9.68d下降到7.85d,平均药费由1672.62元下降到1298.66元。平均抗菌药费用919.94元下降到592.18元。干预后围术期抗菌药预防性应用的合理性明显提高,伤口感染率和院感率无明显变化。结论医院对围术期预防用的抗菌药物实施细则及采取的综合干预措施是有效,可行。为医院拓展预防用抗菌药物干预管理探索了有益的管理经验,对促进安全、合理使用抗菌药起到积极作用。

Integrated use of interventions on the prevention of perioperative evaluation of the impact of antimicrobial agents

Objective The combination of various interventions on perioperative antibiotic prophylaxis impact assessment,to standardize the prophylactic use of antibiotics the hospital and explore the rational basis for management intervention.Methods Author randomly selected 2009 and 2010 surgical patients discharged from the 220 medical records were before as the intervention group and the intervention group before and after intervention survey of perioperative prophylactic use of antimicrobial drugs situation.Results After intervention before surgery 2 h antimicrobials increased from 18.2% down to 3.2%（P0.05）,0.5 ~ 2 h before surgery the proportion of antimicrobial drugs increased from 3.6% to 42%（P0.05）.After surgery,began to use antibiotics increased from 78.2% down to 54.3%（P0.05）,antibiotics to reduce average application time from 8.5d to 5.6 d;average hospital stay fell from the 9.68 d to 7.85d,the average drug cost from the 1672.62 yuan down to 1298.66 yuan.The average cost of 919.94 yuan antibiotics fell to 592.18 yuan.After the intervention of perioperative prophylactic antibiotics significantly improved the rationality,wound infection and hospital infection rate did not change.Conclusion The hospital perioperative preventive use of antimicrobial agents and the implementation rules adopted comprehensive interventions are effective and feasible.Expand the hospital with antibiotics to prevent interference with management to explore a useful management experience,to promote safe and rational use of antimicrobial agents play an active role.