CAJ | 학술논문

目的：通过探讨我院剖宫产手术抗菌药物的应用存在的问题，提高医院合理应用抗菌药物水平，降低手术部位的感染率。方法采用回顾分析法统计分析了2013年1月～2014年9月我院妇产科2730例剖宫产患者围手术期抗菌药物应用情况。结果我院2730例患者预防剖宫产手术感染术后应用抗菌药物比率100%。单用一种抗菌药物预防者1723例（63.11%），应用两种抗菌药物预防者1007例（36.89%），无预防应用三种或三种以上抗菌药物的现象。抗菌药物使用时间为2～7d，使用5d 者最多。抗菌药物预防应用最多的是阿莫西林克拉维酸钾。两种抗菌药物联合预防应用最多的是注射用头孢呋辛和奥硝唑注射液。合理应用抗菌药物的评价中剖宫产手术预防合理者648例（23.74%），不合理占2082例（76.26%）。结论剖宫产手术预防应用抗菌药物存在很多不合理现象，主要体现在选择抗菌药物品种不合理、给药剂量和间隔与说明书规定不符合、选择溶媒错误或溶媒体积过大、预防给药术后输注、预防使用疗程过长、联合应用抗菌药物不合理，并且有多份病历中存在多个不合理用药问题，建议剖宫产手术预防应用抗菌药物按《抗菌药物临床应用指导原则》和《围手术期预防应用抗菌药物指南》加以干预。
목적：통과탐토아원부궁산수술항균약물적응용존재적문제，제고의원합리응용항균약물수평，강저수술부위적감염솔。방법채용회고분석법통계분석료2013년1월～2014년9월아원부산과2730례부궁산환자위수술기항균약물응용정황。결과아원2730례환자예방부궁산수술감염술후응용항균약물비솔100%。단용일충항균약물예방자1723례（63.11%），응용량충항균약물예방자1007례（36.89%），무예방응용삼충혹삼충이상항균약물적현상。항균약물사용시간위2～7d，사용5d 자최다。항균약물예방응용최다적시아막서림극랍유산갑。량충항균약물연합예방응용최다적시주사용두포부신화오초서주사액。합리응용항균약물적평개중부궁산수술예방합리자648례（23.74%），불합리점2082례（76.26%）。결론부궁산수술예방응용항균약물존재흔다불합리현상，주요체현재선택항균약물품충불합리、급약제량화간격여설명서규정불부합、선택용매착오혹용매체적과대、예방급약술후수주、예방사용료정과장、연합응용항균약물불합리，병차유다빈병력중존재다개불합리용약문제，건의부궁산수술예방응용항균약물안《항균약물림상응용지도원칙》화《위수술기예방응용항균약물지남》가이간예。
Objective To explore the problems of prophylaxis usage of antibiotics in cesarean sections to improve rational use of antibiotics and reduce the rate of surgical sites infection. Methods Retrospective analysis of antibiotics usage for 2730 cases of cesarean sections in perioperative period in our hospital from January 2013 to September 2014 was made. Results The rate of using antibiotics to prevent infections after cesarean sections among 2730 cases was 100%. There were 1723 cases which were used single type of antibiotics (63.11%), 1007 cases which were used two types of antibiotics (36.89%) and no cases which were using three or more types of antibiotics. The usage of antibiotics last 2 to 7 days, and most of them used for 5 days. The most frequently used preventive antibiotics was Amoxicillin and Clavulanate Potassium, and the most frequently two combined used preventive antibiotics were cefuroxime for injection and ornidazole injection. In the evaluation on rational usage of antibiotics, 648 cases were prevented rationally in the cesarean sections (23.74%), and 2082 cases were irrationally prevented (76.26%). Conclusion There exists numerous irrational preventive usage of antibiotics in cesarean sections, including irrational choice of antibiotics, non-conformance between administration dosage and interval and package insert, wrong choice or overlarge volume of solvent, postoperative infusion of prophylaxis antibiotics, too long prophylaxis usage course, irrational combined application of antibiotics and irrational administration in numerous medical records. It is suggested that prophylaxis usage of antibiotics in cesarean sections should be interfered with guiding principles of clinical use of antibiotics and guide of perioperative preventive application of antimicrobial agents.