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目的:分析围手术期患者抗菌药物应用情况,为抗菌药物的使用和管理提供科学依据。方法:随机抽取2006年10月-2007年10月手术患者出院病历221份,进行抗菌药物应用合理性评价、用药频度(DDDs)排序和药物利用指数(DUI)测评。结果:221份病例中抗菌药物使用率为93.7%,术前使用抗菌药物的病例为31.2%;在术前使用了抗菌药物的病例中术前2h内用药的只占43.5%;Ⅰ类手术以一联用药为主占73.2%,Ⅱ、Ⅲ类手术以二联用药为主分别占53.9%和61.1%;Ⅰ、Ⅱ、Ⅲ类手术后用药时间超过72h的病例占各类手术比例分别为42.1%,55.7%,76.3%。经5个方面综合评价,Ⅰ、Ⅱ、Ⅲ类手术合理性平均指标分别为33.4%,46.8%,71%。使用的抗菌药物经DDDs排序:三代头孢、替硝唑、氟喹诺酮应用的频次较高;大部分抗菌药物的DUI值<1或接近1。结论:Ⅰ类手术围手术期抗菌药物的应用不合理现象较为突出,Ⅱ类手术次之、Ⅲ类手术用药基本合理。所采用的日剂量控制较好,但用药级别偏高。
Objective: To analyze the application of antimicrobials in perioperative patients and provide scientific basis for the use and management of antimicrobial agents. Methods: Totally 221 medical records of surgeries were collected from October 2006 to October 2007. The rational use of antimicrobial agents, drug use frequency (DDDs) ranking and drug use index (DUI) were evaluated. Results: In 221 cases, the use rate of antimicrobials was 93.7%, preoperative use of antimicrobial agents was 31.2%; preoperative use of antimicrobial drugs accounted for only 43.5% of cases before surgery 2h; type Ⅰ surgery 73.2% were combined with one drug and 53.9% and 61.1% respectively with type II and III were treated with two drugs, and those with type I, II and III medication more than 72 hours accounted for 42.1% %, 55.7%, 76.3%. According to the comprehensive evaluation of five aspects, the average reasonable indexes of type Ⅰ, Ⅱ and Ⅲ were 33.4%, 46.8% and 71% respectively. The antibacterials used were ordered by DDDs: cephalosporins of the third generation, tinidazole, and fluoroquinolone were used more frequently; most of the antibacterials had DUI values <1 or near 1. CONCLUSION: The irrational application of antimicrobial agents in perioperative period of type I surgery is more prominent. The type Ⅱ operation is the second and the type Ⅲ operation is basically rational. The daily dose control is better, but the drug level is high.