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    临床药师干预肝胆胰外科Ⅱ类切口手术围手术期抗菌药物预防应用的效果分析

    Effects of clinical pharmacist intervention on prophylactic application of antibiotics for type Ⅱ incision in hepatopancreatobiliary surgery department

    • 摘要: 目的 探讨临床药师干预对肝胆胰外科Ⅱ类切口手术围手术期预防使用抗菌药物的影响。方法 收集2019年7月—11月和2020年同期Ⅱ类切口手术出院患者的病历资料,分为干预前组和干预后组。按照Ⅱ类切口手术围手术期预防使用抗菌药物评价指标,比较2组预防性抗菌药物选择、预防用药时机、给药剂量,记录干预前后抗菌药物使用频次前5位品种。结果 干预后Ⅱ类切口手术预防用药品种选择不合理率由84.20%下降至23.92%,预防用药品种更换不合理率由15.35%下降至2.29%,无指征联合用药由58.92%下降至15.01%,术前未用术后用由65.24%下降至24.43%,术前>2 h用药由31.38%下降至13.74%,用药疗程>48 h由92.10%下降至14.25%,给药剂量不合理率由67.04%下降至15.52%,差异均具有统计学意义(P<0.05)。干预后含酶抑制剂复合制剂与氟喹诺酮类抗菌药物使用率下降,第二代头孢菌素类抗菌药物的使用率提高。结论 临床药师开展药学干预,可提高肝胆胰外科Ⅱ类切口手术抗菌药物预防使用的合理性。

       

      Abstract: Objective To investigate the effects of clinical pharmacist intervention on prophylactic application of antibiotics for type Ⅱ incision in hepatopancreatobiliary surgery department. Methods The medical records were collected from patients undergoing type Ⅱ incision surgery from July to November 2019 and 2020. The patients were divided into two groups: a pre-intervention group and a post-intervention group. Both groups were evaluated for the prophylactic use of antibiotics in the perioperative period of type Ⅱ incision surgery. Their selection, timing, and dosage of prophylactic use of antibiotics were compared, while the top five types of antibiotics were observed in the two groups. Results The rate of irrational antibiotics selection fell from 84.20% to 23.92%; the irrational rate of medication replacement fell from 15.35% to 2.29%; the rate of combination use without indication fell from 58.92% to 15.01%; the rate of drug use after surgery decreased from 65.24% to 24.43%; the rate of >2 h preoperative use decreased from 31.38% to 13.74%; the rate of >48 h treatment decreased from 92.1% to 14.25%, and the rate of irrational dose fell 67.04% to 15.52%, and the differences were statistically significant (P<0.05). After intervention, the dosing frequencies of enzyme inhibitors containing preparations and fluoroquinolones decreased, while the use of second-generation cephalosporins increased. ConclusionsPharmaceutical intervention by clinical pharmacists can improve the rationality of prophylactic use of antibiotics for type Ⅱ incision in hepatopancreatobiliary surgery department.

       

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