骨科Ⅰ类切口手术围术期预防性应用抗菌药物的调查与分析
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摘要
目的了解深圳市坪山区人民医院(以下简称"我院")骨科Ⅰ类切口手术围术期预防性使用抗菌药物情况,为临床合理预防使用抗菌药物提供一定的参考。方法采用回顾性分析法,对随机抽取的2017年1～9月我院200例骨科Ⅰ类切口手术病例进行评价与分析。结果我院骨科Ⅰ类切口手术围术期抗菌药物抗菌药物预防使用率为55.50%(111/200)。111例预防性使用抗菌药物的患者中,抗菌药物选择合理率为84.68%(94/111);术前0.5～1.0 h给药率为91.89%(102/111);手术切口感染率为18.92%(21/111);预防用药疗程≤24 h者23例,占25.56%(23/90),预防性用药疗程>24 h者67例,占74.44%(67/90)。结论我院骨科Ⅰ类切口手术围术期抗菌药物预防性使用率较高,预防性用药疗程过长,应进一步加强监督管理,促进围术期预防性使用抗菌药物的合理应用。
Objective To understand perioperative antibiotic prophylaxis in orthopedics cases of type Ⅰ incision in People′s Hospital of Pingshan District in Shenzhen City(hereinafter referred to as "the hospital"),so as to provide a certain reference for the rationalantibiotic prophylaxis in clinic.Methods A total of 200 orthopedics cases of typeⅠincision in our hospital from January to September in 2017 were selected randomly,and then were evaluated and analyzed by a retrospective analysis method.Results The prophylacticapplication rate of antibiotics in type Ⅰ incision was55.50%(111/200).Of the 111 patients with prophylactic antibiotics,the rational rate of antibiotics selection was84.68%(94/111),the rate of administration before surgery of 0.5-1.0 h was 91.89%(102/111),the rate of incision infection was 18.92%(21/111),patients with prophylactic treatment course ≤24 h was 23 cases(25.56%,23/90),>24 h was67 cases(74.44%,67/90).Conclusion The prophylacticapplication rate of antibioticsin orthopedics cases of typeⅠincision in our hospitalthe was relatively high,as well as the rate of treatment course more than 24 h.Supervision and management should be further strengthened to promote the reasonable application of perioperative antibiotic prophylaxis.
Objective To understand perioperative antibiotic prophylaxis in orthopedics cases of type Ⅰ incision in People′s Hospital of Pingshan District in Shenzhen City(hereinafter referred to as "the hospital"),so as to provide a certain reference for the rationalantibiotic prophylaxis in clinic.Methods A total of 200 orthopedics cases of typeⅠincision in our hospital from January to September in 2017 were selected randomly,and then were evaluated and analyzed by a retrospective analysis method.Results The prophylacticapplication rate of antibiotics in type Ⅰ incision was55.50%(111/200).Of the 111 patients with prophylactic antibiotics,the rational rate of antibiotics selection was84.68%(94/111),the rate of administration before surgery of 0.5-1.0 h was 91.89%(102/111),the rate of incision infection was 18.92%(21/111),patients with prophylactic treatment course ≤24 h was 23 cases(25.56%,23/90),>24 h was67 cases(74.44%,67/90).Conclusion The prophylacticapplication rate of antibioticsin orthopedics cases of typeⅠincision in our hospitalthe was relatively high,as well as the rate of treatment course more than 24 h.Supervision and management should be further strengthened to promote the reasonable application of perioperative antibiotic prophylaxis.
引文
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[7]卫生部医管司.关于征求《普通外科Ⅰ类(清洁)切口手术围手术期预防用抗菌药物管理实施细则(征求意见稿)》意见的通知[S].2009-11-24.
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[11]史艳光,郭秀芳,吴飞雁,等.内固定取出术围术期是否预防使用抗菌药物对比研究[J].淮海医药,2013,31(2):97-98.
[12]唐婧娴,黄永茂.AmpCβ-内酰胺酶致细菌耐药机制的研究进展[J].西南军医,2014,16(3):300-302.
[13]Lundine KM,Nelson S,Buckley R,et al.Adherence to perioperative antibiotic prophylaxis among orthopedic trauma patients[J].Can J Surg,2010,53(6):367-372.
[14]Slobogean GP,O′Brien PJ,Brauer CA.Single-dose versus multiple-dose antibiotic prophylaxis for the surgical treatment of closed fractures[J].Acta Orthop,2010,81(2):256-262.
[18]TanSK,Lo J,Zwahlen RA.Perioperative antibioticprophylaxis in orthognathic surgery:a systematic reviewand metaanalysis of clinicaltrial[J].Oral Surg,Oral Med,Oral Pathol,Oral Radiol,Endodontol,2011,112(1):19-27.
[16]杨延良,王顺利,史炎鑫.骨科清洁手术预防使用抗菌药物与术后感染的关系[J].临床骨科杂志,2017,20(4):469-472.
[17]王永,张启春,卞慧敏.围手术期预防性使用抗菌药物分析[J].中华医院感染学杂志,2011,21(8):1642-1644.
[18]刘海燕,张琳琳,安佰龙,等.355例骨科Ⅰ类切口手术围术期预防性应用抗菌药物的调查与分析[J].中国医院用药评价与分析,2016,16(8):1120-1122.
[19]杨光辉,杨太明,孔祥如.膝关节镜术后切口感染的预防研究[J].中华医院感染学杂志,2015,25(11):2535-2536,2539.
[20]李国威,黄汉,陈涛,等.骨科手术切口感染的相关因素分析[J].中华医院感染学杂志,2018,28(1):96-98.
[2]WoodsA.Key Points in the CDC's Surgical Site Infection Guideline[J].Adv Skin Wound Care,2005,18(4):215-220.
[3]Berríos-Torres SI,Umscheid CA,BratzlerDW,et al.Centers for Disease Control and Prevention guideline for the prevention of surgical site infection,2017[J].JAMA Surg,2017,152(8):784-791.
[4]吴安华,任南,文细毛,等.193所医院医院感染现患率调查分析[J].中华医院感染学杂志,2002,12(8):6-8.
[5]何缓平,黎沾良,颜青.围手术期预防应用抗菌药物调查分析[J].中华外科杂志,2008,46(1):12-14.
[6]国家卫生计生委办公厅,国家中医药管理局办公室,总后勤部卫生部药品器材局.关于印发《抗菌药物临床应用指导原则(2015年版)》的通知[S].国卫办医,发[2015]43号.2015-07-24.
[7]卫生部医管司.关于征求《普通外科Ⅰ类(清洁)切口手术围手术期预防用抗菌药物管理实施细则(征求意见稿)》意见的通知[S].2009-11-24.
[8]卫生部.卫生部办公厅关于继续深入开展全国抗菌药物临床应用专项整治活动的通知(卫办医政发[2012]32号)[S].2012-03-06.
[9]赵巍,霍建忠.骨科围手术期感染与抗菌药物的应用策略[J].山西医药杂志,2014,43(10):1141-1143.
[10]沈颖,赵婷.骨科清洁手术围术期抗菌药物使用分析[J].河北医药,2015,37(15):2368-2371.
[11]史艳光,郭秀芳,吴飞雁,等.内固定取出术围术期是否预防使用抗菌药物对比研究[J].淮海医药,2013,31(2):97-98.
[12]唐婧娴,黄永茂.AmpCβ-内酰胺酶致细菌耐药机制的研究进展[J].西南军医,2014,16(3):300-302.
[13]Lundine KM,Nelson S,Buckley R,et al.Adherence to perioperative antibiotic prophylaxis among orthopedic trauma patients[J].Can J Surg,2010,53(6):367-372.
[14]Slobogean GP,O′Brien PJ,Brauer CA.Single-dose versus multiple-dose antibiotic prophylaxis for the surgical treatment of closed fractures[J].Acta Orthop,2010,81(2):256-262.
[18]TanSK,Lo J,Zwahlen RA.Perioperative antibioticprophylaxis in orthognathic surgery:a systematic reviewand metaanalysis of clinicaltrial[J].Oral Surg,Oral Med,Oral Pathol,Oral Radiol,Endodontol,2011,112(1):19-27.
[16]杨延良,王顺利,史炎鑫.骨科清洁手术预防使用抗菌药物与术后感染的关系[J].临床骨科杂志,2017,20(4):469-472.
[17]王永,张启春,卞慧敏.围手术期预防性使用抗菌药物分析[J].中华医院感染学杂志,2011,21(8):1642-1644.
[18]刘海燕,张琳琳,安佰龙,等.355例骨科Ⅰ类切口手术围术期预防性应用抗菌药物的调查与分析[J].中国医院用药评价与分析,2016,16(8):1120-1122.
[19]杨光辉,杨太明,孔祥如.膝关节镜术后切口感染的预防研究[J].中华医院感染学杂志,2015,25(11):2535-2536,2539.
[20]李国威,黄汉,陈涛,等.骨科手术切口感染的相关因素分析[J].中华医院感染学杂志,2018,28(1):96-98.