骨科围手术期Ⅰ类切口预防使用抗菌药的管理成效分析

摘 要 目的：促进骨科围术期抗菌药物的合理使用，降低抗菌药物使用强度（AUD）。方法：根据骨科Ⅰ类切口手术种类的风险分级，建立其预防使用抗菌药的管控路径；选取管理路径实施前（2018年1~5月）病例为对照组，管理路径实施后（2018年9月~2019年2月）病例为改进组，以评估管理效果。结果：与对照组相比，改进组的抗菌药物使用总体合理率由38.36%（252/657）提高至76.22%（532/698）。改进后预防药物使用率（20.39% vs 13.14%）和科室AUD（35.68 DDD vs 30.66 DDD）明显降低，抗菌药物使用平均金额也显著下降（555.67元 vs 326.79元）。结论：所建立的骨科围术期Ⅰ类切口预防使用抗菌药物的管控路径具有积极效果。

Analysis of the Effect of Pharmaceutical Intervention on the Preventive Use of Antibiotics in the Perioperative Period of Orthopedic Class I Incisions

Objective: To promote the rational use of antibacterial drugs during the perioperative period and reduce the antibiotics use density (AUD). Methods: On the basis of risk grading of different orthopaedic operations, individualized clinical pathway was carried out to establish the control mode of prophylactic antibiotics during perioperative period. Patients before the implementation of management pathway from January to May 2018 were selected as the control group, and patients from September 2018 to February 2019 were selected as the intervention group to evaluate the effect of management. Results: Compared with the control group, the total correct rate of antimicrobial was increased from 38.36% (252/657) to 76.22% (532/698). The rate of prophylactic drug use and the AUD in the intervention group were decreased from 20.39%, 35.68 DDD to 13.14%, 30.66 DDD, respectively, and the average cost of antibacterial drugs dropped from 555.67 yuan to 326.79 yuan. Conclusion: The establishment of a management and control model for individualized preventive use of antibacterial drugs in different operations during orthopedic perioperative period has reduced the use rate of preventive drugs and the economic burden of patients, and promoted the rational use of perioperative drugs.