结节性甲状腺肿围术期预防性应用抗菌药物的经济学评价

目的:筛选结节性甲状腺肿围术期预防性应用抗菌药物的合理化方案。方法:回顾性调查某院2009—2011年132例结节性甲状腺肿围术期不预防性应用抗菌药物或使用时间在术前0.5～2 h、术后24 h内的病例,按照抗菌药物的应用方案分为4组:无抗菌药物组(21例)、五水头孢唑林钠组(34例)、头孢硫脒组(37例)和头孢呋辛钠组(40例),采用成本-效果分析法进行评价。结果:无抗菌药物组、五水头孢唑林钠组、头孢硫脒组和头孢呋辛钠组的有效率分别为95.2%、97.1%、97.3%、97.5%,差异无统计学意义(P>0.05),其人均成本分别为0、275.4、173.1、34.8元;与头孢呋辛钠组相比较,有效率每提高1个单位,五水头孢唑林钠和头孢硫脒所需成本分别为601.5、691.5元。结论:结节性甲状腺肿围术期可以不使用抗菌药物;必要时,头孢呋辛钠可作为较佳的用药选择。

Pharmacoeconomic Evaluation in Perioperative Use of Prophylactic Antibiotics for Nodular Goiter

OBJECTIVE: To optimize the rational prophylactic antibiotic therapy for perioperative treatment of nodular goiter.METHODS: A total of 132 patients with nodular goiter treated without or with antibiotics 0.5-2 hours before operation or within 24 hours after operation during 2009-2011 were divided into 4 groups: non-antibiotic group(21 cases),cefazolin sodium pentahydrate group(34 cases),cefathiamidine group(37 cases),and cefuroxime sodium group(40 cases).An evaluation of the 4 groups was performed using cost-effectiveness analysis.RESULTS: The effective rates of non-antibiotic group,cefazolin sodium pentahydrate group,cefathiamidine group and cefuroxime sodium group were 95.2%,97.1%,97.3% and 97.5%,respectively,showing no significant differences across the 4 groups(P>0.05),with average costs of 0 yuan,275.4 yuan,173.1 yuan and 34.8 yuan,respectively.The cost for increase of each unit of effective rate stood at 601.5 yuan for cefazolin sodium pentahydrate and 691.5 yuan for cefathiamidine as compared with cefuroxime sodium.CONCLUSION: Perioperative treatment of nodular goiter can be done without using antibiotics,if necessary,cefuroxime sodium serves as an optimal choice.