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目的:分析和评价口腔颌面外科围手术期患者抗菌药物应用的合理性,以提高合理应用抗菌药物的水平。方法:对北京大学口腔医院2009年1～12月出院的颌面外科手术患者病历4037份进行随机抽取,对患者的性别、年龄、手术类别、围手术期抗菌药物应用情况等进行回顾性调查分析,对抗菌药物使用进行合理性评价。结果:总共抽取到997份病例。这些患者中,男506例(50.75%),女491例(49.25%),平均年龄31岁,其中≥60岁167例,≤10岁217例。清洁手术183例(18.36%),清洁-污染手术806例(80.84%),污染手术8例(0.80%)。所有患者均使用抗菌药物,其中使用一种抗菌药物者486例(48.75%),2种抗菌药联用者511例(51.25%);最常用的3类抗菌药物依次为青霉素类(581例,38.53%),硝基咪唑类(447例,29.64%),头孢菌素类(321例,21.29%)。2种药物的联用主要为甲硝唑与青霉素和甲硝唑与头孢呋辛,分别为233例(45.6%)和210例(41.1%);术前预防用药主要以静脉途径给药,但有2例口服给药。979例患者手术预防用药时间合理(术前0.5～2.0h),其中清洁手术、清洁-污染手术和污染手术患者分别为181例(98.91%)、790例(98.01%)和8例(100%);18例患者手术预防用药时机不合理,其中14例术前用药时间<0.5h,4例在术前2.5h。804例患者术后用药合理与基本合理,其中清洁、清洁-污染和污染手术患者分别为125例(68.31%)、671例(83.25%)和8例(100%);193例患者用药不合理,主要为长时间用药,甚至长达10d。围手术期应用抗菌药合理47例(4.71%),基本合理686例(68.81%),合计为733例(73.52%),其中清洁手术121例,清洁-污染手术605例,污染手术7例;不合理为264例(26.48%)。结论:口腔颌面外科围手术期抗菌药物的不合理应用包括无指征用药、药物选用不当、手术预防用药时间不当及术后长时间用药等。因此,应进一步落实有关抗菌药物临床使用的指南,并加强合理用药教育。
OBJECTIVE: To analyze and evaluate the rationality of antimicrobial application in perioperative patients undergoing oral and maxillofacial surgery in order to improve the rational use of antimicrobial agents. Methods: 4037 cases of maxillofacial surgery discharged from Stomatology Hospital of Peking University from January to December in 2009 were randomly selected, and the gender, age, operation type, perioperative antibacterials were retrospectively analyzed , The rational use of antibacterial drugs evaluation. Results: A total of 997 cases were drawn. Among these patients, 506 (50.75%) were male and 491 (49.25%) were female, with a mean age of 31 years, of which 167 were ≥60 and 217 were ≤10 years. There were 183 cases of clean operation (18.36%), 806 cases of clean-polluted operation (80.84%) and 8 cases of polluted operation (0.80%). All patients used antimicrobial agents, including 486 (48.75%) with one antimicrobial agent and 511 (51.25%) with two antimicrobial agents. The three most commonly used antimicrobial agents were penicillin (581, 38.53%), nitroimidazoles (447 cases, 29.64%) and cephalosporins (321 cases, 21.29%). The combination of the two drugs was mainly metronidazole and penicillin and metronidazole and cefuroxime, which were 233 cases (45.6%) and 210 cases (41.1%) respectively. Preoperative prophylaxis was mainly given by intravenous route, There are 2 cases of oral administration. Nine hundred and ninety-seven patients were treated prophylactically for a reasonable period of time (0.5-2.0h preoperatively). Among them, 181 (98.91%), 790 (98.01%) and 8 (100%) patients underwent clean operation, ). The timing of prophylaxis for surgery in 18 patients was unreasonable. Among them, 14 patients preoperatively took less than 0.5 hours and 4 patients preoperatively 2.5 hours. Among 804 patients, there were 125 cases (68.31%), 671 cases (83.25%) and 8 cases (100%) with clean, clean-polluted and contaminated surgeries respectively. The irrational use of 193 patients , Mainly for a long time medication, or even up to 10d. In the perioperative period, there were 47 cases (4.71%) with reasonable antibiotics, accounting for 686 cases (68.81%) with a total of 733 cases (73.52%), including 121 cases of clean operation, 605 cases of clean-polluting operation and 7 cases of polluting operation. Unreasonable to 264 cases (26.48%). CONCLUSION: The irrational use of perioperative antimicrobial agents in oral and maxillofacial surgery includes no indications, improper drug selection, improper time of preventive surgery and long-term postoperative medication. Therefore, guidelines on the clinical use of antimicrobial agents should be further implemented and education on rational drug use should be strengthened.