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目的对比分析《抗菌药物临床应用规范及管理实施细则》实施前后骨折手术患者抗菌药物预防使用情况。方法回顾性分析本院骨三科2010年1月至2014年12月共348例四肢闭合性骨折Ⅰ类切口手术患者使用的抗菌药物种类、疗程、费用、抗菌药物费用占住院总费用比例、术后感染率及住院时间。结果实施前组与实施后组患者的年龄、性别、上下肢分布组间差异均无统计学意义。实施前组患者使用非限制性抗菌药物及限制性抗菌药物分别为20例和151例,实施后组患者使用非限制性抗菌药物及限制性抗菌药物分别为165例和12例,组间差异患者有统计学意义(χ~2=232.15、P<0.001)。实施前组患者抗菌药物疗程、抗菌药物费用和抗菌药物费用占住院总费用比例分别为(4.006±2.279)d、(839.180±678.177)元和(4.674±3.727)%;实施后组患者抗菌药物疗程、抗菌药物费用和抗菌药物费用占住院总费用比例分别为(1.492±0.948)d、(58.081±175.449)元、(0.239±0.546)%。组间差异均具有统计学意义(Z=-12.998、-14.746、-15.270,P均<0.001)。实施前组患者术后感染率和平均住院天数分别为2.339%和(20.440±16.838)d;实施后组患者术后感染率和平均住院天数分别为为1.695%和(20.050±13.922)d,组间差异均无统计学意义。结论实施《抗菌药物临床应用规范及管理实施细则》后,本院骨科预防性使用抗菌药物日趋合理,在未增加感染率及平均住院天数的前提下,有效降低了抗菌药物级别及费用,并缩短了抗菌药物使用疗程。
Objective To compare and analyze the preventive use of antibacterials before and after the implementation of the “Code of Practice of Antibacterials and Management Regulations”. Methods A retrospective analysis of our hospital from January 2010 to December 2014 a total of 348 cases of closed limb fractures type Ⅰ incision surgery patients with antibacterial drugs, treatment, cost, cost of antibacterial drugs accounted for the total cost of hospitalization, surgery Post-infection rate and length of stay. Results There were no significant differences in age, sex, upper and lower extremity distribution between the groups before and after implementation. In the former group, 20 cases and 151 cases were used antibiotics and restrictive antibiotics, respectively. In the latter group, there were 165 cases and 12 cases with non-restrictive antibiotics and restrictive antibiotics, respectively. There were no significant differences between the two groups There was statistical significance (χ ~ 2 = 232.15, P <0.001). The antimicrobial treatment, antimicrobial cost and antimicrobial cost accounted for (4.006 ± 2.279) d, (839.180 ± 678.177) yuan and (4.674 ± 3.727)%, respectively. The antimicrobial treatment (1.492 ± 0.948) d, (58.081 ± 175.449) yuan and (0.239 ± 0.546)%, respectively. The cost of antimicrobial drugs and antimicrobial drugs accounted for 1.492 ± 0.948 d. Differences between the groups were statistically significant (Z = -12.998, -14.746, -15.270, P <0.001). The infection rate and the average length of hospital stay were 2.339% and (20.440 ± 16.838) days respectively in the first group, while the postoperative infection rate and average length of stay in the latter group were 1.695% and 20.050 ± 13.922 d, respectively There was no significant difference between the two groups. Conclusion The implementation of the “Code of Practice for Antibacterial Drugs and Implementation Rules”, orthopedic prophylactic use of antimicrobial agents is becoming more reasonable, without increasing the infection rate and the average length of stay in the premise, effectively reducing the level and cost of antimicrobial agents, and shorten Antibiotics use the treatment.