【摘要】：目的:評價PDCA循環(huán)管理干預(yù)骨科Ⅰ類切口手術(shù)圍術(shù)期抗菌藥物預(yù)防應(yīng)用的效果。方法:采用回顧性分析方法,選取我院PDCA循環(huán)管理干預(yù)前(2013年1-12月,干預(yù)前組)512例、第1輪PDCA循環(huán)管理干預(yù)后(2014年1-12月,第1輪干預(yù)組)861例和第2輪PDCA循環(huán)管理干預(yù)后(2015年1-12月,第2輪干預(yù)組)1 070例行骨科Ⅰ類切口手術(shù)患者的出院病歷,對比分析持續(xù)干預(yù)前后圍術(shù)期抗菌藥物預(yù)防應(yīng)用情況。結(jié)果:經(jīng)2輪PDCA循環(huán)管理干預(yù)后,我院骨科內(nèi)固定術(shù)的構(gòu)成比顯著增加,抗菌藥物使用率、品種合理率、術(shù)前0.5~1h用藥率、療程合理率和有指征使用抗菌藥物的比例分別由干預(yù)前的50.20%、98.08%、93.77%、6.61%和82.10%上升至58.41%、100%、99.04%、52.00%和99.04%;預(yù)防用抗菌藥物的品種由干預(yù)前的4種減少到2種,且選用頭孢唑啉的比例較干預(yù)前顯著增加,選用克林霉素的比例顯著下降;術(shù)后預(yù)防用藥療程由干預(yù)前的(4.63±2.42)d縮短至(1.61±0.75)d,且用藥療程24h和療程為24~48 h的患者比例顯著升高,療程72 h的患者比例顯著下降,差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:PDCA循環(huán)管理提高了我院骨科Ⅰ類切口手術(shù)圍術(shù)期抗菌藥物預(yù)防應(yīng)用的合理率;但我院預(yù)防用抗菌藥物的療程尚未完全控制在24h以內(nèi),有待進(jìn)一步持續(xù)干預(yù)。
[Abstract]:Objective: to evaluate the effect of PDCA circulation management on perioperative antimicrobial application in orthopedic incision. Methods: by retrospective analysis, 512 cases of PDCA circulatory management intervention before intervention (January to December 2013, pre-intervention group) were selected, after the first round of PDCA cycle management intervention (January to December 2014). 861 patients in the first round intervention group and 1 070 patients in the second round PDCA circulation management intervention group (January to December 2015, second intervention group) were discharged from hospital after orthopedic type I incision operation. The application of antimicrobial agents in perioperative period before and after continuous intervention was compared and analyzed. Results: after two rounds of PDCA circulatory management intervention, the composition ratio of orthopedic internal fixation in our hospital increased significantly, the utilization rate of antimicrobial agents, the reasonable rate of variety, and the rate of administration 0.5 h before operation were significantly increased. The reasonable rate of treatment and the proportion of antimicrobial agents with indications increased from 50.20 and 98.08 to 58.41% and 99.04%, respectively, from 6.61% and 82.10% to 58.41% and 99.04%, respectively. The variety of prophylactic antibiotics decreased from 4 before intervention to 2, and the proportion of cefazolin and clindamycin decreased significantly compared with those before intervention. The course of prophylactic medication was shortened from (4.63 鹵2.42) days before intervention to (1.61 鹵0.75) days after intervention, and the proportion of patients who had a course of 24 hours and a course of treatment of 24 ~ 48 hours was significantly increased, and the proportion of patients with 72 hours of treatment decreased significantly. The difference was statistically significant (P0.05). Conclusion: PDCA circulation management has improved the rational rate of prophylactic use of antibiotics in perioperative period of orthopedic incision, but the course of treatment of prophylactic antibiotics in our hospital has not been completely controlled within 24 hours, and further continuous intervention is needed.
【作者單位】： 南寧市第一人民醫(yī)院藥學(xué)部;桂林醫(yī)學(xué)院藥學(xué)院;
【分類號】：R969.3;;R978.1

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