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黄小燕,赵喜荣,曹瑞丽.抗菌药物合理使用对临床手术感染率影响的比较医学分析[J].中国比较医学杂志,2018,28(9):120~125.
抗菌药物合理使用对临床手术感染率影响的比较医学分析
Comparative medical analysis of the effect of rational use of antibacterial drugs on clinical surgical infection rate
投稿时间:2018-05-29  
DOI:10.3969/j. issn. 1671 -7856. 2018. 09. 022
中文关键词:  清洁切口  抗菌药物  围手术期  医院感染
英文关键词:clean incision  antibiotic  perioperative period  nosocomial infection
基金项目:
作者单位E-mail
黄小燕 解放军264 医院感染控制科,太原 030001 675421272@ qq. com 
赵喜荣 解放军264 医院感染控制科,太原 030001  
曹瑞丽 解放军264 医院药剂科,太原 030001  
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全文下载次数: 12
中文摘要:
      目的 了解我院清洁切口感染与抗菌药物合理使用的相关性,比较分析抗菌药物合理使用对临床手术感染率影响,为规范围手术期合理用药和临床干预提供科学依据?方法 通过查阅出院病历,结合应用电子信息平台,采用回顾性调查和实时查阅方法,收录并跟踪清洁切口手术患者?将住院手术患者的姓名?年龄?性别?住院天数?手术名称?手术方式?手术时间?出血量?预防用抗菌药物品种?用药时机?用药天数?使用方法?疗程?联合用药和院内感染及切口愈合等情况录入Excel 表,建立数据库?并根据国家卫生部《医院感染诊断标准(试行)》和《外科手术部位感染预防与控制技术指南》对切口感染进行诊断?通过统计学分析,比较抗菌药物合理使用对临床手术率的影响?结果 970 例清洁切口手术病例中有317 例未使用抗菌药物,预防性使用抗菌药物有653 例,总使用率为67. 32%?653 例清洁切口手术患者围手术期预防使用抗菌药物时间分布为:术前0. 5 ~ 2 h 用药为437例,占66. 92%;术前未使用,术后使用的190 例,占29. 10%,其中急诊手术有123 例;术前提前1 d 使用的有26 例,占3. 98%,其中,围手术期用药< 24 h 者有194 例,占29. 71%;术后24 ~48 h 者有164 例,占25. 11%;术后48 ~72h 者有101 例,占15. 47%;术后超过72 h 者有194 例,占29. 71%;用药指征合理的有516 例,用药指征合理性占79. 02%?970 例清洁切口手术患者中,甲级愈合例数为945 例,甲级愈合率为97. 42%;切口感染发生5 例,为0. 52%,符合国家有关清洁切口医院感染率≤ 1. 5%的规定?结论 通过对563 例围手术期病例使用抗菌药物的合理性比较分析得出,79. 02%的病例在手术期间使用抗菌药物合理,清洁切口感染率小于1. 5%,符合有关规定?但是围手术期抗菌药物使用与国家卫生部有关要求有一定差距,应进一步加强抗菌药物临床合理使用管理与监督?
英文摘要:
      Objective The rational use of antibiotics is critical for the prevention of surgical site infection. Therefore, revealing its relationship with the infection of clean incisions and its impact on the clinical surgical infection rate would provide a scientific basis for the rational use of drugs and clinical interventions during the surgical period. Methods Patients who had undergone cleaning of infected incisions were registered and tracked according to the medical records from an electronic information platform, which allows retrospective and real?time investigation. The following information was recorded and analyzed in an Excal form: name, age, sex, length of hospital stay, operation, amount of bleeding, information on antibacterial drug use, combination drug therapy, nosocomial infection and incision healing, and the database was built. Wound infection was diagnosed based on Hospital Infection Diagnostic Criteria (Trial) and Surgical Site Hospital Infection Prevention and Control Technical Guidelines issued by the Ministry of Health. Finally, the effect of rational use of antibiotics on clinical operation was evaluated according to the results of statistical analysis. Results There were a total of 970 cases registered with incision cleaning in this study. Prophylactic antibiotics were used in 653 cases, with a use rate of 67. 32%. The cases with antibiotics usage in the perioperative period were divided into three groups based on the time distribution of antibiotic treatment: there were 437 cases (66. 92%) with the usage of antibiotics 0. 5 - 2 h before the operation, 190 cases (29. 10%) with the usage after the operation, of which emergency operation accounted for 123 cases, and 26 cases (3. 98%) with the usage 1 day before the surgery. Among the 653 cases, 194 cases (29. 71%)were recorded with antibiotic usage in the perioperative period < 24 h, 164 cases (25. 11%) 24 - 48 h after the operation, 101 cases (15. 47%) 48 - 72 h after the operation, and 194 cases (29. 71%) > 72 h after the operation. There were 516 cases with reasonable indications, at a rate of 79. 02%. Among the total of 970 patients included in the study with incision cleaning in surgery, the number of grade A healing cases was 945, with the grade A healing rate being 97. 42%, leaving 5 cases (0. 52%) suffering from incision infection. Therefore, the infection rate met the national regulations on nosocomial infection rate of clean incisions of ≤ 1. 5%. Conclusions Through a comparative analysis of the rationality of 563 cases with perioperative use of antibacterial drugs, 79. 02% of the cases were reasonable in terms of antibiotic usage during the operation, and the clean incision infection rate was less than 1. 5%, in line with national regulations. However, there is a certain gap between the use of antibiotics in the perioperative period and the requirements of the Ministry of Health. The management and supervision of the rational use of antimicrobial drugs should be further strengthened.
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