实行综合干预措施后对骨科围手术期抗感染药物的应用影响.docx

实行综合干预措施后对骨科Ⅰ类切口手术围手术期抗感染药物的应用影响袁波，李玲，黄芳，陆文杰（同济大学附属第十人民医院药剂科，上海，200072）【摘 要】 目的：比较干预前后我院骨科Ⅰ类切口手术预防使用抗菌药情况，为进一步规范我院围手术期预防使用抗菌药物提供依据。方法：采用回顾性调查方法，随机选取2011年第3季度（干预前）和2012年第3季度（干预后）骨科Ⅰ类切口手术，统计、分析围手术期预防使用抗菌药情况，并评价其合理性。结果：抗菌药预防使用率干预后由84.67%下降到57.30%（P0.01），抗菌药费用明显减少（P＜0.01），用药合理性明显提高。结论：我院为规范骨科Ⅰ类切口围手术期预防使用抗菌药采取的综合干预措施可行、有效。关键词 综合干预；骨科Ⅰ类切口手术；预防使用抗菌药；围手术期 Effects of comprehensive interventions on prophylactic use of antibiotics in class Ⅰ Orthopedic surgery Yuan Bo, Li Ling ,Huang Fang, Lu Wen-jie (Department of Pharmacy ,The Tenth people’s Hospital of Tongji University, Shanghai, 200072)ABSTRACT OBJECTIVE: In order to standardize preventive use of antibiotics during perioperative period in our hospital, a control study was conducted to compare the preventive use of antibiotics in class Ⅰ orthopedic surgery before-and-after interventions. METHODS: According to retrospective methods, the surgery cases were randomly selected from the third quarter of 2011 (pre-intervention group) and the third quarter of 2012 (post-intervention group) , respectively. The preventive use of antibiotics class Ⅰ orthopedic surgery was analyzed and evaluated. RESULTS: In the post-intervention group, the proportion of cases using antibacterial was obviously reduced, the antibacterial costs was decreased significantly, the rationality of antibiotics use was obviously enhanced. CONCLUSIONS: The comprehensive intervention measures in order to optimize the preventive use of antibiotics during perioperative period in our hospital are effective and feasible.KEY WORDS comprehensive intervention; class Ⅰ orthopedic surgery; preventive use of antibiotics; perioperative period[基金项目]上海申康医院发展中心临床管理优化项目（SHDC2011613）:抗菌药物合理使用的药事管理和效果评估。[作者简介]袁波（1976-），男（汉族），学士，主管药师。Email:yuanbo1376@163.com. 按照《卫生部办公厅关于进一步加强抗菌药物临床应用管理的通知》（卫办医发〔2009〕38号）的规定[1]，根据手术部位是否需要植入物，骨科手术区分为一般骨科手术和应用人工植入物的骨科手术，我院一般骨科手术共有126种，应用人工植入物的骨科手术有247种，每月进行的骨科Ⅰ类切口手术例数占全院总手术例数的1/4，手术种类多，手术量大，围手术期抗感染合理用药的管理难度大。我院抗菌药物临床应用管理小组从2012年1月起结合抗菌药物合理应用软件的运行，