临床路径实施前后结节性甲状腺肿治疗中抗菌药物应用分析

目的探讨普通外科结节性甲状腺肿实施临床路径后抗菌药物的应用是否得到规范和改进。方法回顾性调查2009年11月至2010年8月临床路径实施前后165例患者抗菌药物的应用情况,分为非路径组(87例)和路径组(78例)。结果两组患者抗菌药物使用率均为100%,平均住院日由实施路径前的7.89 d缩短为6.86 d。非路径组与路径组患者的预防用药率分别为83.91%和97.44%,预防使用频率较高的均为第2代头孢菌素和青霉素类,术前0.5～2 h预防给药率分别是60.27%和81.58%,术后72 h内停药率分别为49.43%和55.13%,抗菌药物的平均使用天数分别为4.72 d和3.95 d。两组均以预防用药、单独用药为主,联合用药较少,联合用药率从21.84%下降到6.41%。结论临床路径实施后,该院普通外科结节性甲状腺肿手术患者抗菌药物的使用在术前给药时机和联合用药方面得到较好改善,术后72 h内停药率明显上升。但在预防用药品种的选择上无明显改善,在实施过程中应进一步加强规范。

Analysis on Application of Antibacterial Drugs in Treating Nodular Goiter before and after Implementation of Clinical Pathway

Objective To analyze whether the application of antibacterial drugs has been standardized and improved to cure nodular goiter in the general surgery department before and after the implementation of clinical pathway.Methods 165 patients with nodular goiter from November 2009 to August 2010 were divided into non-pathway group（87 cases） and pathway group（78 cases）,the antibacterial drugs applications according to the clinical pathway of nodular goiter were analyzed retrospectively and statistically.Results The use rate of antibacterial drugs in the two groups was 100%.The average hospitalization time was shortened from 7.89 d before implementation of clinical pathway to 6.86 d after implementation of clinical pathway.The rates of preventive using of the antibacterial drugs were 83.91%and 97.44%respectively.The higher frequency of using was second-generation cephalosporin and penicillin.The rates of preventive using of antibacterial drugs in 0.5-2 h were 60.27%and 81.58%respectively.The rates of drug withdrawal in postoperative 72 h were 49.43%and 55.13%respectively.The average using time of antibacterial drugs were 4.72 d and 3.95 d respectively.The medication in the two groups was mainly preventive and single use with less drug combination.The rates of antibacterial drugs combination were decreased from 21.84%to 6.41%.Conclusion After the implementation of clinical pathway,the preventive application and the combination of antibacterial drugs were better improved in curing nodular goiter in the general surgery department.The rate of drugs withdrawal in postoperative 72 h has been significantly increased.The using time of antibacterial drugs and the average hospitalization time were effectively shortened.However,the variety choice of preventive using of antibacterial drugs has not been significantly improved,which should be strengthened to further standardize during implementation.