CAJ | 학술논문

目的：了解围手术期抗菌药物应用状况，通过分析为调整抗菌药物目录并提高合理用药提供参考。方法采用回顾性调查的方法，随机抽取我院2013年1～12月7个科室的419例患者病历，对围手术期抗菌药物使用情况进行统计和分析。结果419例手术患者中，I类切口手术256例（预防性应用抗菌药物250例，达97.66%），Ⅱ类切口手术106例（预防性应用抗菌药物100%），Ⅲ类切口手术44例（预防性应用抗菌药物100%），Ⅳ类切口手术13例（属于治疗性应用抗菌药物）；抗菌药物使用率达98.57%。术前0.5~2h给药46例（10.98%），术前24h给药215例（51.31%），术后给药152例（36.28%）。平均疗程7.2d，其中，术后用药时间≤24h者2例（0.48%），术后用药时间≤72h者24例（5.73%），应用4～8d者364例（86.87%），应用超过10d者23例（5.49%）。预防用抗菌药物共24种，一代头孢菌素类3种，二代头孢类2种，三代头孢类3种，四代头孢类1种，喹诺酮类3种，其他类12种；单用1种抗菌药物301例，联合2种抗菌药物98例，联合3种抗菌药物14例；给药剂量不适宜36例，给药频次不适宜19例。结论我院围手术期应用抗菌药物不合理，存在相关实验室检查缺失、指征掌握不严、选药针对性不强、给药时机不适宜、术后疗程过长、给药频次、剂量不适宜等诸多问题，亟待进一步规范管理。
목적：료해위수술기항균약물응용상황，통과분석위조정항균약물목록병제고합리용약제공삼고。방법채용회고성조사적방법，수궤추취아원2013년1～12월7개과실적419례환자병력，대위수술기항균약물사용정황진행통계화분석。결과419례수술환자중，I류절구수술256례（예방성응용항균약물250례，체97.66%），Ⅱ류절구수술106례（예방성응용항균약물100%），Ⅲ류절구수술44례（예방성응용항균약물100%），Ⅳ류절구수술13례（속우치료성응용항균약물）；항균약물사용솔체98.57%。술전0.5~2h급약46례（10.98%），술전24h급약215례（51.31%），술후급약152례（36.28%）。평균료정7.2d，기중，술후용약시간≤24h자2례（0.48%），술후용약시간≤72h자24례（5.73%），응용4～8d자364례（86.87%），응용초과10d자23례（5.49%）。예방용항균약물공24충，일대두포균소류3충，이대두포류2충，삼대두포류3충，사대두포류1충，규낙동류3충，기타류12충；단용1충항균약물301례，연합2충항균약물98례，연합3충항균약물14례；급약제량불괄의36례，급약빈차불괄의19례。결론아원위수술기응용항균약물불합리，존재상관실험실검사결실、지정장악불엄、선약침대성불강、급약시궤불괄의、술후료정과장、급약빈차、제량불괄의등제다문제，극대진일보규범관리。
Objective To analyze the perioperative use of antimicrobial drugs , provide the reference for the adjustment of antibacterial drugs directory and improve rational drug use. Methods Retrospectively analyzed the medical record from 419 subjects who were randomly selected from seven departments during 2013 by multistage sampling method. Results 256 cases accepted type I incision operation (the preventive use of antibiotics in 250 cases of 97.66%), 106 cases accepted type IIinci-sion operation (preventive application of antimicrobial drugs in 100%), 44 cases accepted class Ⅲ incision operation (preven-tive application of antimicrobial drugs in 100%), 13 cases accepted type Ⅳ incision operation (belonging to the therapeutic ap-plication of antimicrobial agents);antibiotic usage was 98.57%. Preoperative for 0.5~2h was administered for 46 patients (10.98%), preoperative for 24h was administered for 215 patients (51.31%), 152 cases(36.28%) of postoperative to medicine. The mean duration of treatment was 7.2d. 2 cases of postoperative medication time was equal to or over 24h (0.48%), 24 cases of postoperative medication time was equal to or over 72h (5.73%), 4~8d in 364 cases (86.87%), 23 cases of application of more than 10d (5.49%). Preventive application of antibiotics was 24 kinds,a generation cephalosporins was 3 kinds, the second generation cephalosporins was 2 kinds, the third generation cephalosporinsis was 3 kinds, the fourth generation cephalosporins was 1 kind, quinolones was 3 kinds, and others were 12 kinds; 301 cases used one antimicrobial agents, 98 cases used two antimicrobial agents, 14 cases used 3 kinds of antibiotics; the dosage was not suitable for 36 cases, dosing frequency was not suitable for 19 cases. Conclusion The application of antibiotics of perioperation period of our hospital is not reasonable , it lack of relevant laboratory examination, lack of indications and drug targeted being not strong. Administrating time is not appro-priate, postoperative treatment is too long, dosing frequency and dosage are not suitable. It urgently needs further standardize the management.