3种清洁切口手术围手术期预防用抗菌药物管理成效

目的探讨某院监控合理使用抗菌药物前后甲状腺、乳腺、疝修补3种清洁切口手术围手术期预防用抗菌药物的合理性以及监控措施实施的效果。方法抽取2008年6月1日-2009年5月31日（监控前组）及2009年7月1日-2010年6月30日（监控后组）间所有甲状腺、乳腺、疝修补手术患者病历2 408份，对照研究监控前后预防用抗菌药物的合理性。结果对合理使用抗菌药物进行监控后,抗菌药物使用率由监控前的97.94%(1 093/1 116)下降至89.09%(1 151/1 292)；联合用药率由37.63%(420/1 116)下降至13.39%(173/1 292)；术前2 h内的预防用药率由60.13%（671/1 116）增加至77.24%（998/1 292）；平均抗菌药物费用占总费用比例及占药费比例均明显下降（P＜0.05）；监控前后清洁切口Ⅰ/甲愈合率（分别为99.19%与99.30%）差异无统计学意义（P＞0.05）。结论医院采取监控措施可显著提高抗菌药物的合理使用率，降低抗菌药物费用，对促进临床安全、有效、经济地应用抗菌药物具有良好效果。

Management effect on prophylactic use of antimicrobial agents during perioperative period of clean incision operations

Objective To evaluate the rationality of antimicrobial application during perioperative period of three clean incision operations including thyroid surgery, breast surgery, and hernia repairing surgery before and after monitoring rational use of antimicrobial agents in a hospital, and survey the effect of the intervention measures. Methods 2 408 case histories of patients who were hospitalized from June l, 2008 to May 31, 2009 （prearinterven- tion group） and from July 1, 2009 to June 30, 2010 （post-intervention group） were collected and compared. Results After intervention, the percentage of antimicrobial use decreased from 97. 94 % （ 1 093/1 116） to 89. 09 %（ 1 151 / 1 292）; combination use rate declined from 37. 63% （420/1 116） to 13. 39% （173/1 292） ;prophylactic use rate 2 hours before operations increased from 60. 13% （671/1 116） to 77. 24%（998/1 292） ; the ratios of average expense of antimicrobial use to the total expense and to all drug expense decreased obviously, respectively（p〈0. 05） ; There was no statistical difference in Margin 1/armour healing rate of incision between two groups （99. 19% vs 99. 39%, p〉 9. 05）. Conchusion The intervention management can improve the rational use of antimicrobial agents, reduce expense of mtimicrobial agents, and as well as promote the safe, etfective and economical clinical application of antimicrobial agents.