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目的:探讨施行《上海市〈抗菌药物临床应用指导原则〉实施细则(试行)》(简称《实施细则》)对我院普外科手术患者预防性用药的影响。方法:采用回顾性调查方法,将我院2006年9月～2008年2月普外科住院手术患者分为3组(《实施细则》颁布前6个月,组1;颁布后0～6个月,组2;颁布后7～12个月,组3),对其抗菌药物的应用情况及合理性进行分析。结果:共有1308例患者符合入组条件,应用抗菌药物3463频次,其中符合抗菌药物应用指征者不足半数,仅1.2%进行了药敏试验。组1、组2、组3抗菌药物应用疗程分别为(3.4±4.3)、(3.3±2.9)、(3.1±3.0)d;总体合理用药比例分别为36.5%、35.1%、40.7%。但抗菌药物品种选择、联合用药、不良反应报道等未见明显改善。结论:《实施细则》的施行对我院普外科抗菌药物的规范应用已显示促进作用,但仍需进一步培训督查。
Objective: To explore the impact of the implementation of the Shanghai Municipality (Guidelines for the Implementation of Clinical Guidelines for Antibacterials) (Trial Implementation) (the “Regulations”) on the prophylactic use of general surgical patients in our hospital. Methods: The retrospective investigation method was used to divide the general surgery inpatients of our hospital from September 2006 to February 2008 into 3 groups (6 months prior to promulgation of the Regulations, Group 1; 0 to 6 months after promulgation , Group 2; 7 to 12 months after the promulgation, group 3), the application of the antibacterial drugs and rationality analysis. Results: A total of 1308 patients were eligible for enrollment. The frequency of antibacterials was 3463, less than half of them were in line with the indications for antimicrobial use, and only 1.2% were tested for susceptibility. The courses of antimicrobial treatment in group 1, group 2 and group 3 were (3.4 ± 4.3), (3.3 ± 2.9) and (3.1 ± 3.0) days, respectively. The overall rational drug use rates were 36.5%, 35.1% and 40.7% respectively. However, no significant improvement was found in the selection of antibacterial drugs, combination therapy and adverse reaction reports. Conclusion: The implementation of the "Rules for the implementation of general surgery in our hospital antimicrobial drugs have been shown to promote the role, but still need further training and supervision.