吴传红　陈韵蓓　王小玲

[摘要] 目的 評价药学干预抗菌药物使用在骨科Ⅰ类切口围术期的效果。 方法 通过医院DIS系统调取四川省骨科医院2016年1～6月（干预前，对照组127例）和2017年1～6月（干预后，干预组133例）Ⅰ类切口围术期应用抗菌药物的患者的电子病历，对药学干预前后骨科Ⅰ类切口手术围术期预防用抗菌给药时机、药物品种、用法用量、用药疗程等情况进行回顾性对照分析。 结果 经干预，干预组骨科I类切口围术期用药时机合理比例明显上升为84.2%，与对照组（51.2%）比较，差异有高度统计学意义（χ2=32.81，P=0.000）；干预组用药品种合理比例与对照组比较，差有高度统计学意义（χ2=46.27，P=0.000）；抗菌药物干预前后给药途径均为静脉滴注，两组在给药途径上比较，差异无统计学意义（P > 0.05），但干预组用药剂量、用药频次的规范率明显高于对照组（χ2=23.11，P=0.000；χ2=36.32，P=0.000）；两组抗菌药物用药疗程在<24 h的手术比较，差异无统计学意义（P > 0.05）；干预组用药疗程在24～48 h的手术高于对照组（χ2=23.78，P=0.000）；干预组用药疗程在>48 h的手术低于对照组（χ2=18.42， P=0.000）。 结论 药学干预对骨科Ⅰ类切口围术期使用抗菌药物的效果确切，可有效提高抗菌药物合理应用率，减少不规范用药的发生，值得推广。

[关键词] 药学干预；抗菌药物；Ⅰ类切口围术期；骨科

[中图分类号] R197 [文献标识码] A [文章编号] 1673-7210（2018）04（b）-0139-04

[Abstract] Objective To evaluate the effect on pharmaceutical intervention of the perioperative antimicrobial drugs use in typeⅠincision in Orthopedic Department. Methods Through the DIS system of hospital， electronic medical records of perioperative antibacterial drugs used in typeⅠincision in Sichuan Orthopedic Hospital from January to June 2016 （before intervention， 127 cases in control group） and from January to June 2017 （after intervention， 133 cases in intervention group） were selected. The time of administration， drug varieties， usage and dosage， medication treatment， and so on of perioperative antibacterial drugs used in typeⅠincision in orthopedic department before and after the intervention were retrospectively analyzed. Results After intervention， the reasonable proportion of the time of administration of perioperative antibacterial drugs varieties used in intervention group was significantly increased to 84.2%， and it compared with the control group （51.2%）， the difference was highly statistically significant （χ2=32.81， P=0.000）. The rational proportion of perioperative antibacterial drugs used in intervention group was compared with the control group， the difference was highly statistically significant （χ2=46.27， P=0.000）. Administration route of antimicrobial drugs before and after the intervention were intravenous drip， and the two groups were compared on the route of administration， the difference was not statistically significant （P > 0.05）， but the dosage and frequency of medication in intervention group were higher than those of the control group （χ2=23.11， P=0.000， χ2=36.32， P=0.000）. The antibacterial drug of treatment in the operation of < 24 h in the two groups were compared， the difference was not statistically significant （P > 0.05）. The medication treatment in the operation of 24-48 h in the intervention group was higher than the control group （χ2=23.78， P=0.000）. The medication treatment in the operation of > 48 h in the intervention group was lower than the control group （χ2=18.42， P=0.000）. Conclusion The effect of pharmaceutical intervention of the perioperative antimicrobial drugs use in typeⅠincision in Orthopedic Department is definite， and can effectively improve the rational utility ratio of antibacterial drugs， reduce the occurrence of non-standard drugs use， which is worth promoting.

[Key words] Pharmaceutical intervention； Antibiotics； TypeⅠincision perioperative period； Orthopaedic Department

随着健康事业中关于医学研究的创新和进步，临床药品的品种及数目增加明显。随之出现的不规范用药情况也不断涌现，给临床用药的安全性及有效性带来了挑战。不规范用药会给患者的身心健康带来不良影响，严重者会危及性命[1-2]。据报道指出，不规范用药是多数患者出现死亡的重要原因之一，其中以围术期抗菌药物的不合理应用最为明显[3]。因此……