某“三甲”综合性医院腹腔镜手术围手术期抗菌药物预防使用情况调查及合理性评价(1)
中图分类号 R978；R969.3 文献标志码 A 文章编号 1001-0408(2018)08-1065-04
DOI 10.6039/j.issn.1001-0408.2018.08.13
摘 要 目的：为进一步提高腹腔镜手术围手术期预防使用抗菌药物的合理性提供参考。方法：利用相关信息系统软件调取我院2016年1月1日-12月31日所有5 288例住院行腹腔镜手术患者的电子病历和医嘱信息，就其围手术期抗菌药物预防使用情况进行回顾性调查，并进行医嘱合理性评价。结果：5 288例腹腔镜手术患者中有1 890例在围手术期使用了抗菌药物预防感染，抗菌药物预防使用率为35.7%；其中，胃、十二指肠、小肠手术抗菌药物预防使用率最高(69.4%)，而肝胆系统及胰腺手术抗菌药物预防使用率也达到68.0%，腹外疝手术未发现预防使用抗菌药物。1 890例在围手术期预防使用抗菌药物的患者以单独用药居多(83.4%)；使用频率排前3位的分别是头孢呋辛钠(63.9%)、甲硝唑(13.5%)和头孢噻肟鈉(11.8%)。有151例(8.0%)在围手术期预防使用抗菌药物的患者存在不合理医嘱，其中以用药不适宜医嘱中的遴选药品不适宜居多(50.3%)，其次为不规范用药医嘱中的用药疗程不适宜(27.8%)。结论：我院腹腔镜手术围手术期预防使用抗菌药物的总体情况尚可，但部分参照Ⅰ类切口手术管理的手术抗菌药物预防使用率相对较高，且部分预防用药医嘱仍存在不合理用药现象。需制定符合本院实际情况的抗菌药物预防使用管理规范，同时加强对腹腔镜手术围手术期预防使用抗菌药物的医嘱点评工作，并强化相关合理用药宣教。
关键词 腹腔镜手术；抗菌药物；预防使用；调查；合理性评价；合理用药
ABSTRACT OBJECTIVE： To provide reference for further improving the rationality of perioperative prophylactic use of antibiotics in laparoscopy surgery. METHODS： Electronic medical records and medical orders of 5 288 inpatients underwent laparoscopy surgery were collected from our hospital during Jan. 1st-Dec. 31st， 2016 by using related information system software. The perioperative prophylactic use of antibiotics was investigated retrospectively. Rationality of medical orders was evaluated. RESULTS： Among 5 288 patients underwent laparoscopy surgery， 1 890 patients used antibiotics for infection prevention during perioperative period. The rate of prophylactic use of antibiotics was 35.7%. The rate of prophylactic use of antibiotics in stomach， duodenum and small intestine operation was the highest (69.4%)； the rate of prophylactic use of antibiotics in hepatobiliary and pancreatic surgery also reached 68.0%； prophylactic use of antibiotics was not found in the surgery of abdominal external hemia. The majority of 1 890 patients who had used antibiotics prophylactically during perioperative period used antibiotics alone (83.4%). Top 3 drugs in the list of use frequency were cefuroxime sodium (63.9%)， metronidazole (13.5%) and cefotaxime sodium (11.85). There were irrational medical orders in 151 cases (8.0%) of perioperative prophylactic use of antibiotics； among prescriptions of irrational drug use， the majority was unsuitable drug selection (50.3%)， followed by unsuitable drug selection among nonstandard medical orders. CONCLUSIONS： The overall situation of perioperative prophylactic use of antibiotics is basically satisfactory in laparoscopic surgery of our hospital. The rate of prophylactic use of antibiotics is relatively high in type Ⅰ incision surgery， and irrational drug use is found in some medical orders of prophylactic drug use. It is necessary to formulate regulations for prophylactic use of antibiotics in accordance with the actual situation of the hospital， strengthen medical order evaluation for perioperative prophylactic use of antibiotics in laparoscopy surgery， relevant rational drug use education., 百拇医药(陈猛 舒志兵 周月红)
DOI 10.6039/j.issn.1001-0408.2018.08.13
摘 要 目的：为进一步提高腹腔镜手术围手术期预防使用抗菌药物的合理性提供参考。方法：利用相关信息系统软件调取我院2016年1月1日-12月31日所有5 288例住院行腹腔镜手术患者的电子病历和医嘱信息，就其围手术期抗菌药物预防使用情况进行回顾性调查，并进行医嘱合理性评价。结果：5 288例腹腔镜手术患者中有1 890例在围手术期使用了抗菌药物预防感染，抗菌药物预防使用率为35.7%；其中，胃、十二指肠、小肠手术抗菌药物预防使用率最高(69.4%)，而肝胆系统及胰腺手术抗菌药物预防使用率也达到68.0%，腹外疝手术未发现预防使用抗菌药物。1 890例在围手术期预防使用抗菌药物的患者以单独用药居多(83.4%)；使用频率排前3位的分别是头孢呋辛钠(63.9%)、甲硝唑(13.5%)和头孢噻肟鈉(11.8%)。有151例(8.0%)在围手术期预防使用抗菌药物的患者存在不合理医嘱，其中以用药不适宜医嘱中的遴选药品不适宜居多(50.3%)，其次为不规范用药医嘱中的用药疗程不适宜(27.8%)。结论：我院腹腔镜手术围手术期预防使用抗菌药物的总体情况尚可，但部分参照Ⅰ类切口手术管理的手术抗菌药物预防使用率相对较高，且部分预防用药医嘱仍存在不合理用药现象。需制定符合本院实际情况的抗菌药物预防使用管理规范，同时加强对腹腔镜手术围手术期预防使用抗菌药物的医嘱点评工作，并强化相关合理用药宣教。
关键词 腹腔镜手术；抗菌药物；预防使用；调查；合理性评价；合理用药
ABSTRACT OBJECTIVE： To provide reference for further improving the rationality of perioperative prophylactic use of antibiotics in laparoscopy surgery. METHODS： Electronic medical records and medical orders of 5 288 inpatients underwent laparoscopy surgery were collected from our hospital during Jan. 1st-Dec. 31st， 2016 by using related information system software. The perioperative prophylactic use of antibiotics was investigated retrospectively. Rationality of medical orders was evaluated. RESULTS： Among 5 288 patients underwent laparoscopy surgery， 1 890 patients used antibiotics for infection prevention during perioperative period. The rate of prophylactic use of antibiotics was 35.7%. The rate of prophylactic use of antibiotics in stomach， duodenum and small intestine operation was the highest (69.4%)； the rate of prophylactic use of antibiotics in hepatobiliary and pancreatic surgery also reached 68.0%； prophylactic use of antibiotics was not found in the surgery of abdominal external hemia. The majority of 1 890 patients who had used antibiotics prophylactically during perioperative period used antibiotics alone (83.4%). Top 3 drugs in the list of use frequency were cefuroxime sodium (63.9%)， metronidazole (13.5%) and cefotaxime sodium (11.85). There were irrational medical orders in 151 cases (8.0%) of perioperative prophylactic use of antibiotics； among prescriptions of irrational drug use， the majority was unsuitable drug selection (50.3%)， followed by unsuitable drug selection among nonstandard medical orders. CONCLUSIONS： The overall situation of perioperative prophylactic use of antibiotics is basically satisfactory in laparoscopic surgery of our hospital. The rate of prophylactic use of antibiotics is relatively high in type Ⅰ incision surgery， and irrational drug use is found in some medical orders of prophylactic drug use. It is necessary to formulate regulations for prophylactic use of antibiotics in accordance with the actual situation of the hospital， strengthen medical order evaluation for perioperative prophylactic use of antibiotics in laparoscopy surgery， relevant rational drug use education., 百拇医药(陈猛 舒志兵 周月红)