摘要
目的比较临床药师深度参与普外科Ⅰ类切口精细化管理前后围手术期抗菌药物合理用药情况。方法共纳入351例普外科Ⅰ类切口手术患者抗菌药物使用记录,其中管理前99例(2022年5月—10月),管理后第1年122例(2023年5月—10月),管理后第2年130例(2024年5月—10月)。采用基于前置审方系统的精细化管理模式,由临床药师依据Ⅰ类切口抗菌药物用药规则进行医嘱前置审方,并结合事中干预、事后点评、定期考核与培训等措施,对比管理前后普外科Ⅰ类切口手术围手术期抗菌药物合理使用情况。结果管理后第1年,抗菌药物用药指征、药物选择、给药时机、用药疗程及用法用量合理使用率分别由管理前的29.29%、66.67%、46.46%、67.68%、75.76%提高至82.79%、86.07%、81.15%、90.98%、89.34%(P均<0.01);管理后第2年,上述各项合理使用率进一步提高,分别达到90.77%、91.54%、88.46%、95.38%、99.23%(P均<0.01)。但管理前后重复用药合理使用率差异无统计学意义(P>0.05)。与管理前相比,管理后喹诺酮类、三代头孢菌素、头霉素类、硝基咪唑类等不适宜药物的使用减少,其中喹诺酮类使用下降尤为明显(P<0.05)。结论临床药师深度参与精细化管理后,可有效改善普外科Ⅰ类切口围手术期抗菌药物不合理用药情况,减少抗菌药物不规范使用,确保患者安全合理用药。
Objective To compare the rational use of perioperative antibiotics in general surgery patients undergoing classⅠincisions before and after the in-depth involvement of clinical pharmacists in refined management.Methods A total of 351 antibiotic use records from patients undergoing class I incision general surgery were included,comprising 99 cases before management(May to October 2022),122 cases in the first year after management(May to October 2023),and 130 cases in the second year after management(May to October 2024).A refined management model based on a preprescription review system was applied,in which clinical pharmacists performed pre-prescription review according to class I incision antibiotic use rules,combined with real-time intervention,post-prescription evaluation,periodic assessment,and training.The rationality of perioperative antibiotic use before and after management was compared.Results In the first year after management,the rates of rational use regarding antibiotic indication,drug selection,timing of administra⁃tion,treatment duration,and dosage improved from 29.29%,66.67%,46.46%,67.68%,and 75.76%before manage⁃ment to 82.79%,86.07%,81.15%,90.98%,and 89.34%,respectively,with statistically significant differences(all P<0.01).In the second year after management,these rates further increased to 90.77%,91.54%,88.46%,95.38%,and 99.23%,all differences reaching statistical significance(all P<0.01).No significant difference was observed in the rationality of repeated medication use before and after treatment(P>0.05).Compared with pre-management,the use of in⁃appropriate antibiotics,including quinolones,third-generation cephalosporins,penicillins,and nitroimidazoles,de⁃creased after management,with quinolones showing the most marked reduction(all P<0.05).Conclusion The indepth involvement of clinical pharmacists in refined management significantly improved perioperative antibiotic use in general surgery patients with classⅠincisions,reduced inappropriate prescriptions,and ensured safe and rational medi⁃cation.
作者
吕蒙蒙
李婷
王慧
朱慧芳
LYU Mengmeng;LI Ting;WANG Hui;ZHU Huifang(Department of Pharmacy,Xuzhou Hospital of Traditional Chinese Medicine,Xuzhou 221010,China)
出处
《山东医药》
2026年第1期122-126,共5页
Shandong Medical Journal
基金
江苏省徐州市卫生健康委药学科研项目(XWYXKY202205)。
关键词
Ⅰ类切口
抗菌药物
前置审方
精细化管理
临床药师
class I incision
antimicrobial agent
pre-prescription review
refined management
clinical pharmacist
