外科Ⅰ类切口手术围手术期预防应用抗菌药物的干预管理

目的为规范医院外科围手术期抗菌药物预防性应用,探索合理干预管理措施。方法选取普外科甲状腺手术、乳腺手术、疝气修补术3种Ⅰ类切口手术病例,对其围手术期预防用抗菌药物实施3个阶段连续性综合干预,并对干预前后预防用抗菌药物合理性进行评价分析,以考查干预管理效果。结果通过3个阶段连续性干预管理,抗菌药物应用率由干预前100.00%分别下降为干预后3个阶段的60.47%、46.30%、33.33%;用药频次由干预前1.65次/例分别下降为干预后3个阶段的0.85、0.67、0.39次/例;抗菌药物合理应用率明显提高,分别由干预前0上升为干预后3个阶段的44.19%、69.44%、79.31%;干预后不合理应用抗菌药物的表现形式均有不同程度改善;平均抗菌药物费用由干预前988.17元分别下降为干预后81.25、118.50、115.15元。结论医院制定的3种Ⅰ类切口手术围手术期预防用抗菌药物实施细则及采取的综合干预管理措施有效、可行,为医院拓展其他Ⅰ类切口手术以及外科Ⅱ、Ⅲ类切口手术围手术期合理预防用抗菌药物干预管理探索了有益的管理经验。

Intervention Management on Prophylactic Use of Antibiotics During Perioperative Period of Class Ⅰ Surgical Incision Operations in Our Hospital

OBJECTIVE To standardize the using principles of antibiotics during perioperative period in our hospital by exploring reasonable interventions.METHODS Three types of class Ⅰ surgical incision operations including thyroid surgery,breast surgery,and hernia neoplasty were selected by clustering.The data of medication after three-stage continuous integrated intervention were collected and compared.RESULTS The percentage of antibiotics use was much lower,from 100.00% pre-intervention to 60.47%,46.30%,and 33.33% after three-stage intervention.The frequency of administration declined from 1.65 times-cases to 0.85,0.67,and 0.39 times-cases after three-stage intervention management.There was a remarkable improvement on the rationality ofantibiotics use,from 0.00%tO 44.19%,69.44%,and 79.31%after three-stage intervention management.The reasons of the irrationally utilizing antibiotics were significantly improved after intervention management.The average costs of antibiotics remarkably dropped from 988.17 yuan to 81.25 yuan,118.50 yuan,and 115.15yuan after three-stage intervention management.CONCLUSIONS The integrated intervention management is effective and feasible.The reasonable intervention can significantly improve the rational use of antibiotics,which have explored some useful management experience for carrying out more intervention management on reasonable prophylactic use of antibiotics during perioperative period about other class Ⅰ and some class Ⅱ and Ⅲ surgical incision operations in our hospital.