300例手术患者抗菌药物使用的调查分析(1)
【摘要】目的：探讨手术患者抗菌药物的使用及其合理性，进一步规范手术科室正确使用抗菌药物。方法：随即抽查我院2006年12月~2007年9月进行手术的外科出院病历300份，调查分析其抗菌药物的使用情况。结果：300例围手术期患者除1人外均使用抗菌药物，其中预防用药占87.7%，术前2h内给药者占预防用药的8.4%；抗菌药物的使用疗程为0~45天，多数病历3~7天，Ⅰ类切口平均使用4.9天，Ⅱ类切口平均使用5.8天，术后预防用药最长16天；多数病历为单用或二联，共用品种多为1~2种；用药频数由高到低前5位为左氧氟沙星、甲硝唑、阿莫西林舒巴坦钠、头孢唑肟、头孢西丁。结论：手术科室普遍采用抗菌药物预防手术部位的感染，但严格按照围手术期预防用药原则应用者少，手术后预防用药时间长，选用品种起点高，I类切口存在不必要联用，必须采取措施加强围手术期抗菌药物的使用管理。
【关键词】手术患者；抗菌药物；调查分析
文章编号：1009-5519(2008)04-0495-03 中图分类号：R9 文献标识码：A
, 百拇医药
Survey and analysis of antibiotics for 300 patients with surgical operations
CHEN Yao，ZENG Ming-hui，LI Ping
(Department of Pharmacy，Sichuan Provincial People's Hospital，Sichuan Academy of Medical Sciences，Chengdu 610072，China)
【Abstract】Objective：To investigade the usage of antibiotics in surgical department and explore their rationality for improving the proper clinical utilization. Methods：A total of 300 patients with surgical operation who discharged from our hospital from dec.2006 to sep.2007 were surberyed retrospectively. Results：All patients except one were given antibiotics.The rate of antibiotics was 87.7%.8.4% were received antibiotics in two hours before the operation.The duration of antibiotics usage was 0~45 days.most of that were 3~7 days. The duration of postoperation prophylaxis was：or Ⅰ type incision average 4.9 days and for Ⅱ type incision average 5.8 days，the longest one was 16 days in type I incision. Most patients were received one or two kinds of antibiotics during hospitalization.The sequence of the frequency of antibiotics usage was (from high to low)：Levofloxacin，Metronidazolee，Amoxicillin-Sulbactam，Ceftizoxime，Cefoxitin. Conclusion：It is common that antibiotics are used to prevent surgical system infection in surgical department but most don't follow the principle of antibiotics prophylaxis during perioperative period.The majoy problems are excessive prophylaxis in surgical system，long duration of antibiotics prophylaxis after operation，excessive selection to expensive antibiotics and unnecessary combination on antibiotics. It is important to strengthen the management of antibiotics.
, 百拇医药
【Key words】Surgical operation；Antibiotics；Survey and analysis
抗菌药物在预防和治疗感染性疾病中起着至关重要的作用，但在临床广泛应用的同时，不合理使用的现象也较为普遍，导致不良反应增多，院内感染和药源性疾病发生率增加，并造成巨大的资源浪费[1]。为了解目前外科手术患者抗菌药物的使用情况，我们随机抽查了本院手术科室300例手术病例，对其抗菌药物的使用情况进行了调查分析。
1 资料与方法
1.1 资料来源：随机抽取本院2006年12月~2007年9月出院手术病例，每月30份，共300份，填写调查表，这些病例分布在肝胆外科、胃肠外科、神经外科、眼科、口腔科、耳鼻喉科、妇产科、整形外科、泌尿外科、心胸外科、血管外科、骨科、乳腺外科。
1.2 调查内容：患者资料包括患者病历号、性别、年龄、体重、出入院时间、科室、诊断、过敏史、手术名称、切口类别、手术持续时间、治疗结果。用药情况包括抗菌药物名称、用法用量、用药频数、总用量、用药起止时间、术前用药、术中用药情况、病原学检测、药敏试验。
, http://www.100md.com
2 结果
2.1 一般情况：调查的300例手术患者中，男156例，女144例；年龄3个月~87岁；手术切口Ⅰ类162例，Ⅱ类132例，Ⅲ类6例，治疗结果：治愈240例，好转59例，死亡1例，5例进行了病原学检测及药敏试验。
2.2 抗菌药物使用情况：300份被调查病例除1例外均使用了抗菌药物，其中预防用药263例，占87.7%，治疗用药37例，占12.3%，Ⅰ类切口手术前2h内预防给药者22例，占预防用药的8.4%，术前>2h给药者64例，占预防用药的24.3%，术后预防给药177例，占预防用药的67.3%，手术时间≥3h有32例，术中追加4例。其中4例为口服用药，其余均通过静脉途径给药。
2.3 抗菌药物的应用疗程为0~45天，手术后预防用药时间为0~18天，手术后预防用药时间见表1。
2.4 抗菌药物联合应用：单一用药225例，二联用药74例。只用1种占192例，先后用药2种76例，3种17例，4种3例，5种1例。, 百拇医药(陈 瑶 曾明辉 李 平)
【关键词】手术患者；抗菌药物；调查分析
文章编号：1009-5519(2008)04-0495-03 中图分类号：R9 文献标识码：A
, 百拇医药
Survey and analysis of antibiotics for 300 patients with surgical operations
CHEN Yao，ZENG Ming-hui，LI Ping
(Department of Pharmacy，Sichuan Provincial People's Hospital，Sichuan Academy of Medical Sciences，Chengdu 610072，China)
【Abstract】Objective：To investigade the usage of antibiotics in surgical department and explore their rationality for improving the proper clinical utilization. Methods：A total of 300 patients with surgical operation who discharged from our hospital from dec.2006 to sep.2007 were surberyed retrospectively. Results：All patients except one were given antibiotics.The rate of antibiotics was 87.7%.8.4% were received antibiotics in two hours before the operation.The duration of antibiotics usage was 0~45 days.most of that were 3~7 days. The duration of postoperation prophylaxis was：or Ⅰ type incision average 4.9 days and for Ⅱ type incision average 5.8 days，the longest one was 16 days in type I incision. Most patients were received one or two kinds of antibiotics during hospitalization.The sequence of the frequency of antibiotics usage was (from high to low)：Levofloxacin，Metronidazolee，Amoxicillin-Sulbactam，Ceftizoxime，Cefoxitin. Conclusion：It is common that antibiotics are used to prevent surgical system infection in surgical department but most don't follow the principle of antibiotics prophylaxis during perioperative period.The majoy problems are excessive prophylaxis in surgical system，long duration of antibiotics prophylaxis after operation，excessive selection to expensive antibiotics and unnecessary combination on antibiotics. It is important to strengthen the management of antibiotics.
, 百拇医药
【Key words】Surgical operation；Antibiotics；Survey and analysis
抗菌药物在预防和治疗感染性疾病中起着至关重要的作用，但在临床广泛应用的同时，不合理使用的现象也较为普遍，导致不良反应增多，院内感染和药源性疾病发生率增加，并造成巨大的资源浪费[1]。为了解目前外科手术患者抗菌药物的使用情况，我们随机抽查了本院手术科室300例手术病例，对其抗菌药物的使用情况进行了调查分析。
1 资料与方法
1.1 资料来源：随机抽取本院2006年12月~2007年9月出院手术病例，每月30份，共300份，填写调查表，这些病例分布在肝胆外科、胃肠外科、神经外科、眼科、口腔科、耳鼻喉科、妇产科、整形外科、泌尿外科、心胸外科、血管外科、骨科、乳腺外科。
1.2 调查内容：患者资料包括患者病历号、性别、年龄、体重、出入院时间、科室、诊断、过敏史、手术名称、切口类别、手术持续时间、治疗结果。用药情况包括抗菌药物名称、用法用量、用药频数、总用量、用药起止时间、术前用药、术中用药情况、病原学检测、药敏试验。
, http://www.100md.com
2 结果
2.1 一般情况：调查的300例手术患者中，男156例，女144例；年龄3个月~87岁；手术切口Ⅰ类162例，Ⅱ类132例，Ⅲ类6例，治疗结果：治愈240例，好转59例，死亡1例，5例进行了病原学检测及药敏试验。
2.2 抗菌药物使用情况：300份被调查病例除1例外均使用了抗菌药物，其中预防用药263例，占87.7%，治疗用药37例，占12.3%，Ⅰ类切口手术前2h内预防给药者22例，占预防用药的8.4%，术前>2h给药者64例，占预防用药的24.3%，术后预防给药177例，占预防用药的67.3%，手术时间≥3h有32例，术中追加4例。其中4例为口服用药，其余均通过静脉途径给药。
2.3 抗菌药物的应用疗程为0~45天，手术后预防用药时间为0~18天，手术后预防用药时间见表1。
2.4 抗菌药物联合应用：单一用药225例，二联用药74例。只用1种占192例，先后用药2种76例，3种17例，4种3例，5种1例。, 百拇医药(陈 瑶 曾明辉 李 平)