抗菌药物管理对Ⅰ类切口手术围术期抗菌药物使用合理性的影响(1)
[摘要]目的 探討抗菌药物管理对Ⅰ类切口手术围术期抗菌药物使用合理性的影响。方法 选取2018年4月～2019年11月于我院行Ⅰ类切口手术的300例住院患者作为研究对象，以2019年1月为抗菌药物管理正式实践点，将2018年4～12月接收的148例患者视为管理前，将2019年1～11月接收的152例患者视为管理后，比较抗菌药物管理前后抗菌药物的使用比例、Ⅰ类切口手术患者预防使用抗菌药物的情况。结果 实施管理后，Ⅰ类切口手术抗菌药物使用率由管理前的79.73%(118/148)下降至21.71%(33/152)，差异有统计学意义(P<0.05)。抗菌药物管理前围术期预防性使用抗菌药物类型以第一、三代头孢菌素为主，且存在药物联用现象，抗菌药物管理后以第一、二代头孢菌素为主，无药物联用现象，且管理后第一、二、三代头孢菌素使用率与管理前比较，差异有统计学意义(P<0.05);而其他抗菌药物管理前后使用率比较，差异无统计学意义(P>0.05)。实施管理后，临床在药物品种选择、持续给药时间以及给药时机合理率均高于管理前，在无适应证用药、用法用量不当及溶剂选择不恰当率低于管理前，差异有统计学意义(P<0.05)。结论 抗菌药物管理的实施能明显增加Ⅰ类切口手术围术期抗菌药物使用的合理性，有效提高抗菌药物管理过程的质量评价，从而保障患者的用药安全性。
[关键词]抗菌药物管理;Ⅰ类切口;手术;围术期;合理性
[中图分类号] R969.3 [文献标识码] A [文章编号] 1674-4721(2020)8(b)-0186-04
[Abstract] Objective To explore the effect of antimicrobial stewardship on the rationality of antimicrobial use in perioperative period of type Ⅰ incision surgery. Methods From April 2018 to November 2019， 300 inpatients who underwent type Ⅰ incision surgery in our hospital were selected as the research objects. January 2019 was taken as the official practice point of antimicrobial stewardship. From April to December 2018， the 148 patients admitted to our hospital were considered as before management， and the 152 patients from January to November 2019 were treated as after management. The proportion of antimicrobial use before and after antimicrobial stewardship and the prophylactive use of antibacterial drugs in patients with type I incision surgery were compared. Results After the implementation of management， the use rate of antimicrobial drugs for type I incision surgery decreased from 79.73% (118/148) before management to 21.71% (33/152)， the difference was statistically significant (P<0.05). The type of preventive use of antibacterial drugs in the perioperative period before antibacterial stewardship was mainly the first and third generation cephalosporins， and there was a phenomenon of drug combination. After management of antibacterial stewardship， the first and second generation cephalosporins took the majority without joint use， and the use rate of the first， second and third generation cephalosporins after management， compared with before management， the differences were statistically significant (P<0.05). For other antibacterial drugs， there was no significant difference in use rate before and after management (P>0.05). After management of antibacterial stewardship， the clinical selection of drug varieties， the duration of drug administration， and the reasonable rate of drug administration were higher than those before the management， and the rate of medication without indication， improper usage and dosage， and inappropriate choice of solvent were lower than those before the management， the differences were statistically significant (P<0.05). Conclusion The implementation of antimicrobial stewardship can significantly increase the rationality of the use of antimicrobial drugs in the perioperative period of type Ⅰ incision surgery， and effectively improve the quality evaluation of the antimicrobial stewardship process， thereby ensuring the safety of patients′ medication., 百拇医药(刘章生 廖圆月 李嘉泓)
[关键词]抗菌药物管理;Ⅰ类切口;手术;围术期;合理性
[中图分类号] R969.3 [文献标识码] A [文章编号] 1674-4721(2020)8(b)-0186-04
[Abstract] Objective To explore the effect of antimicrobial stewardship on the rationality of antimicrobial use in perioperative period of type Ⅰ incision surgery. Methods From April 2018 to November 2019， 300 inpatients who underwent type Ⅰ incision surgery in our hospital were selected as the research objects. January 2019 was taken as the official practice point of antimicrobial stewardship. From April to December 2018， the 148 patients admitted to our hospital were considered as before management， and the 152 patients from January to November 2019 were treated as after management. The proportion of antimicrobial use before and after antimicrobial stewardship and the prophylactive use of antibacterial drugs in patients with type I incision surgery were compared. Results After the implementation of management， the use rate of antimicrobial drugs for type I incision surgery decreased from 79.73% (118/148) before management to 21.71% (33/152)， the difference was statistically significant (P<0.05). The type of preventive use of antibacterial drugs in the perioperative period before antibacterial stewardship was mainly the first and third generation cephalosporins， and there was a phenomenon of drug combination. After management of antibacterial stewardship， the first and second generation cephalosporins took the majority without joint use， and the use rate of the first， second and third generation cephalosporins after management， compared with before management， the differences were statistically significant (P<0.05). For other antibacterial drugs， there was no significant difference in use rate before and after management (P>0.05). After management of antibacterial stewardship， the clinical selection of drug varieties， the duration of drug administration， and the reasonable rate of drug administration were higher than those before the management， and the rate of medication without indication， improper usage and dosage， and inappropriate choice of solvent were lower than those before the management， the differences were statistically significant (P<0.05). Conclusion The implementation of antimicrobial stewardship can significantly increase the rationality of the use of antimicrobial drugs in the perioperative period of type Ⅰ incision surgery， and effectively improve the quality evaluation of the antimicrobial stewardship process， thereby ensuring the safety of patients′ medication., 百拇医药(刘章生 廖圆月 李嘉泓)