Ⅱ类手术切口患者171例围手术期抗菌药应用分析

目的 探讨Ⅱ类切口围手术抗菌药预防使用存在的问题,以减少抗菌药的不合理应用。方法 对同济大学附属东方医院2015年12月至2016年1月胃肠外科、肝胆胰外科、急创外科、妇产科手术Ⅱ类切口患者171例预防性抗菌药应用情况进行回顾性调查分析。结果 在随机抽取171例Ⅱ类切口手术患者中,抗菌药预防性用药171例(100%),联合使用两种抗菌药42例(24.56%),预防性应用抗菌药排在前6位的依次是第2代头孢菌素、第3代头孢菌素、头菌素类、第1代头孢菌素、青霉素类、单环β-内酰胺类。围手术平均用药时间:胃肠外科5.29d,肝胆胰外科6.13d,急创外科3.5d,妇产科3d。结论 围手术期Ⅱ类切口预防应用抗菌药存在术前预防用药时间不规范、抗菌药选择级别高、无指征延长用药、联用抗菌药比例高等不规范现象。需加强抗菌药应用规范的管理,提高临床用药的科学性。
Objective To survey the status of perioperative use of antibacterial agents in type Ⅱ incision surgery. Methods One hundred and seventy one patients undergoing various type Ⅱ incision surgeries, including gastrointestinal surgery, hepato-pancreato-biliary surgery, emergency surgery, gynecological and obstetric surgery, in East Hospital atfiliated to Tongji University from December 2015 to January 2016 were included in the study. The perioperative use of antibacterial agents was retrospectively analyzed. Results All 171 patients received preventive antimicrobial agents, including 42 cases (24.56%) treated with the combination of two types of antibiotic agents. The most frequently used drug was the second generation cephalosporin, followed by the third generation cephalosporin, the first generation cephalosporin, cephalosporin, penicillin and monocyclic β-lactam antibiotics. The average duration of perioperative antibiotic use was 5.29d for gastrointestinal surgery, 6.13d for hepato-pancreato-biliary surgery, 3.5d for emergency surgery, 3.0d for gynecological and obstetric surgery. Conclusion The irrational perioperative use of antibiotic agents in type Ⅱ incision surgery includes irrational course, high level antibiotics and high ratio of combined antibiotics usage