2017-2018年解放军第九四六医院普外科Ⅰ类切口手术围术期预防用抗菌药物的合理性分析

目的 分析2017-2018年解放军第九四六医院普外科Ⅰ类切口手术围术期预防用抗菌药物的合理性。方法 选取解放军第九四六医院普外科2017-2018年收治的Ⅰ类切口手术患者381例为研究对象，对围术期抗菌药物的适应症、给药时机、用药疗程、抗菌药物品种、联合用药情况进行分析。结果 选取的381例Ⅰ类切口手术患者中，使用抗菌药物的患者有157例（41.21%），使用率较高的手术有体表肿物切除术（58.24%）、其他手术（59.42%）和静脉曲张术（46.15%），而甲状腺手术（34.33%）、乳腺手术（23.08%）、腹股沟氙修补术（24.51%）的抗菌药物使用率均超过20%。抗菌药物品种使用频率最高的是头霉素类的头孢西丁、头孢米诺，占比34.39%，其次为氨基糖苷类的硫酸依替米星，占比33.12%，以及硝基咪唑类的奥硝唑，占比17.20%。术前0.5~1 h给药的患者有137例（87.26%），术前>1 h或术后给药的患者有20例（12.74%）；用药疗程<24 h的患者有143例（91.08%），用药疗程>24 h的患者有14例（8.92%）。联合用药均为二联用药，构成比为48.41%，其中奥硝唑联合头孢西丁使用例数最多，共45例（59.21%）。结论 解放军第九四六医院在Ⅰ类切口手术围术期预防性抗菌药物的使用存在诸多问题，存在用药指征把握不严、药物品种选择不够恰当、联合用药情况严重等，尚需进一步建立健全的合理应用抗菌药物的管理制度。

Analysis on reasonable use of prophylactic antibacterial drugs in perioperative period of type I incision in Department of General Surgery of 946 Hospital of PLA from 2017 to 2018

Objective To analyze the rationality of perioperative prophylactic antibiotics for type I incision surgery in Department of General Surgery of 946 Hospital of PLA from 2017 to 2018. Methods Patients (381 cases) with type I incision operation in Department of General Surgery of 946 Hospital of PLA from 2017 to 2018 were selected as the study subjects, and the indication of perioperative prophylactic antibiotics, delivery time, course of administration, antimicrobial species, and drug combination was analyzed. Results Among 381 cases of patients underwent type I incision operation, 157 cases (41.21%) were treated with antibiotics. Operation with high use rate of antibiotics included excision of body surface tumors (58.24%), other operations (59.42%), and varicose veins (46.15%), and the use rate of antibiotics in thyroid surgery (34.33%), breast surgery (23.08%), and inguinal xenon repair (24.51%) were more than 20%. The antibiotics with most frequently use rate were cefoxitin and cefminox, accounting for 34.39%. The second was etimicin sulfate of aminoglycosides, accounting for 33.12%, ornidazole of nitroimidazoles accounted for 17.20%. Patients (137 cases, 87.26%) were given 0.5-1 h before operation, and patients (20 cases, 12.74%) were given more than 1 h before operation or after operation. Patients (143 cases, 91.08%) were treated for less than 24 h, and patients (14 cases, 8.92%) were treated for more than 24 h. Drug combination were combined with two drugs, accounting for 48.41%. The combination of ornidazole and cefoxitin was the most commonly used combination, with a total of 45 cases (59.21%). Conclusion There are many problems in the use of prophylactic antibacterial drugs in perioperative period of type I incision in Department of General Surgery of 946 Hospital of PLA, such as improper indication of drug use, inappropriate selection of drug varieties, and serious situation of combined drug use. It is necessary to further establish and improve the management system of rational use of antibiotics.