CAJ | 학술논문

目的：了解基层医院手术切口细菌分布与抗菌药物使用情况，为临床合理应用抗菌药物提供依据。方法采用单盲方法，对某基层医院住院治疗的246例患者手术切口提取物进行细菌培养，对围手术期抗菌药物临床应用情况进行调查统计，与国家卫生部、中华医学会等制定的合理用药相关规定和有关文献资料进行比较分析。结果246例患者手术切口检出病原菌79株，其中大肠埃希菌53株（67.09％），表皮葡萄球菌24株（30.38％），铜绿假单胞菌2株（2.53％）。医生对246例患者均不考虑手术切口类别而经验性使用了6类14种抗菌药物417例次，抗菌药物使用率100％，使用频次最多的是二代头孢菌素（50.60％）。大多数围手术期抗菌药物的使用存在无适应证用药、药物选择混乱、用药疗程过长、用药时间把握不准、载体溶媒配伍不当等问题。结论基层医院手术切口感染的革兰阳性细菌主要是表皮葡萄球菌；目前围手术期抗菌药物的使用依然普遍不合理，应采取更为积极有效的刚性干预和监管措施，进一步促进抗菌药物临床合理应用。
목적：료해기층의원수술절구세균분포여항균약물사용정황，위림상합리응용항균약물제공의거。방법채용단맹방법，대모기층의원주원치료적246례환자수술절구제취물진행세균배양，대위수술기항균약물림상응용정황진행조사통계，여국가위생부、중화의학회등제정적합리용약상관규정화유관문헌자료진행비교분석。결과246례환자수술절구검출병원균79주，기중대장애희균53주（67.09％），표피포도구균24주（30.38％），동록가단포균2주（2.53％）。의생대246례환자균불고필수술절구유별이경험성사용료6류14충항균약물417례차，항균약물사용솔100％，사용빈차최다적시이대두포균소（50.60％）。대다수위수술기항균약물적사용존재무괄응증용약、약물선택혼란、용약료정과장、용약시간파악불준、재체용매배오불당등문제。결론기층의원수술절구감염적혁란양성세균주요시표피포도구균；목전위수술기항균약물적사용의연보편불합리，응채취경위적겁유효적강성간예화감관조시，진일보촉진항균약물림상합리응용。
Objective To know the bacterial distribution on surgical incision and antimicrobial application in primary hospital and provide the basis for clinical antibacterial drug application .Methods Bacterial culture was per-formed in 246 patients′surgical incision treated in primary hospital by single blind , and recorded antimicrobial appli-cation in perioperative period ,then compared and analyzed it with related regulations and reference from Chinese med-ical association and national hygiene department .Results Seventy-nine strains of pathogenic bacteria had been de-tected in 246 patients′surgical incision , including 53 strains of E .coli ( 67.09%) , 24 strains of Staphylococcus (30.38%) and 2 strains of pseudomonas aeruginosa (2.53%).The 246 patients used 6 class,14 kinds of antibacteri-al drugs,417 times without considering the surgical incision category , the usage rate of antibacterial drug was 100%, second generation cephalosporin was the most frequently used (50.60%), there were problems of without indications drugs,most of the perioperative use of antimicrobial medicine , chaotic medicine choices, too long medication,inaccu-rate medication time , and improper carrier solvent existed in the perioperative period of most antimicrobial applica -tion.Conclusion The main gram positive bacteria of surgical incision is epidermis staphylococcus in primary hospi -tal;the antimicrobial application in perioperative period at present is still generally unreasonable , more effective inter-vention and supervision measures should be adopted ,in order to further promote the reasonable antimicrobial applica-tion in clinic .