Ⅰ类切口手术抗菌药物合理预防性应用调查分析(1)
[摘要] 目的 探讨在该院的手术条件下，预防性应用抗菌药物对Ⅰ类清洁切口手术患者切口感染的影响。 方法 随机抽取该院2013年1月—2015年12月间收治的653例Ⅰ类清洁切口手术，按照患者有无高危因素、是否预防性应用抗菌药物进行分组，统计各组患者切口感染率，进行对比分析。结果 有高危因素的Ⅰ类清洁切口手术未预防性应用抗菌药物组比有高危因素的Ⅰ类清洁切口手术预防性应用抗菌药物组患者切口感染率提高了17.28%；无高危因素的Ⅰ类清洁切口手术未预防性应用抗菌药物组比无高危因素的Ⅰ类清洁切口手术预防性应用抗菌药物组患者切口感染率只提高了0.31%。结论 在该院的手术条件下，有高危因素的Ⅰ类清洁切口手术应预防性应用抗菌药物，可有效地降低患者切口感染率；无高危因素的Ⅰ类清洁切口手术可无需应用抗菌药物进行手术预防，切口感染率变化不大，验证了Ⅰ类清洁切口手术预防用药指征在该院的适用性。
[关键词] Ⅰ类清洁切口手术；预防性应用抗菌药物；对比分析
[中图分类号] R978.1 [文献标识码] A [文章编号] 1674-0742(2016)04(c)-0038-03
[Abstract] Objective To study the effect of predictive application of antibacterials on the incision infection of patients with type I clean incision operation in the operative conditions of our hospital. Methods 653 cases of patients with type I clean incision operation treated in our hospital from January 1， 2013 to December 31， 2015 were randomly extracted and divided into groups according to whether the patients had the high-risk factors or not and whether they predictively applied antibacterials， and the incision infection rate of each group was counted， compared and analyzed. Results The incision infection rate of the group with type I clean incision operation with high-risk factor and without predictive application of antibacterials increased by 17.28% compared with that of the group with type I clean incision operation with high-risk factor and with predictive application of antibacterials， but the incision infection rate of the group with type I clean incision operation without high-risk factor and without predictive application of antibacterials only increased by 0.31% compared with that of the group with type I clean incision operation without high-risk factor and with predictive application of antibacterials. Conclusion In the operative conditions of our hospital， the type I clean incision operation with high-risk factor should predictively apply antibacterials， and it can effectively reduce the incision infection rate of patients， the type I clean incision operation without high-risk factor does not need apply antibacterials for operative prediction， and the change of the incision infection rate is not big， which verifies the applicability of type I clean incision operation in predicting the medicinal indication in our hospital.
[Key words] Type I clean incision operation； Predictive application of antibacterials； Compare and analyze
Ⅰ类切口手术为清洁手术，手术部位无污染，并且不涉及炎症区域。因此，新版《抗菌药物临床应用指导原则》[1]规定Ⅰ类清洁切口手术通常不需预防性应用抗菌药物，但在下列情况时可考虑预防用药：①手术范围大、时间长、污染机会增加；②手术涉及重要重要脏器，一旦感染会造成严重后果；③异物植入手术；④有感染高危因素如高龄、糖尿病、免疫低下、营养不良等患者，需预防使用抗菌药物[1]。抗菌药物的预防性应用并不能代替严格的消毒、灭菌技术和精湛的无菌操作，也不能代替术中保温和血糖控制等其他预防措施[2]。因医院不同，手术室环境各异，严格按照Ⅰ类清洁切口手术预防用药指征用药，是否会提高患者切口感染率，延长患者住院时间和增加治疗费用[3]，成为手术医师最关注的问题。该研究通过对该院2013年1月—2015年12间收治的Ⅰ类清洁切口手术653例病历分组进行对比分析，探讨在该院的手术条件下，预防性应用抗菌药物对患者切口感染率的影响，验证Ⅰ类清洁切口手术预防用药指征在该院的适用性，为临床合理用药提供参考。报道如下。 (郭宝均)
[关键词] Ⅰ类清洁切口手术；预防性应用抗菌药物；对比分析
[中图分类号] R978.1 [文献标识码] A [文章编号] 1674-0742(2016)04(c)-0038-03
[Abstract] Objective To study the effect of predictive application of antibacterials on the incision infection of patients with type I clean incision operation in the operative conditions of our hospital. Methods 653 cases of patients with type I clean incision operation treated in our hospital from January 1， 2013 to December 31， 2015 were randomly extracted and divided into groups according to whether the patients had the high-risk factors or not and whether they predictively applied antibacterials， and the incision infection rate of each group was counted， compared and analyzed. Results The incision infection rate of the group with type I clean incision operation with high-risk factor and without predictive application of antibacterials increased by 17.28% compared with that of the group with type I clean incision operation with high-risk factor and with predictive application of antibacterials， but the incision infection rate of the group with type I clean incision operation without high-risk factor and without predictive application of antibacterials only increased by 0.31% compared with that of the group with type I clean incision operation without high-risk factor and with predictive application of antibacterials. Conclusion In the operative conditions of our hospital， the type I clean incision operation with high-risk factor should predictively apply antibacterials， and it can effectively reduce the incision infection rate of patients， the type I clean incision operation without high-risk factor does not need apply antibacterials for operative prediction， and the change of the incision infection rate is not big， which verifies the applicability of type I clean incision operation in predicting the medicinal indication in our hospital.
[Key words] Type I clean incision operation； Predictive application of antibacterials； Compare and analyze
Ⅰ类切口手术为清洁手术，手术部位无污染，并且不涉及炎症区域。因此，新版《抗菌药物临床应用指导原则》[1]规定Ⅰ类清洁切口手术通常不需预防性应用抗菌药物，但在下列情况时可考虑预防用药：①手术范围大、时间长、污染机会增加；②手术涉及重要重要脏器，一旦感染会造成严重后果；③异物植入手术；④有感染高危因素如高龄、糖尿病、免疫低下、营养不良等患者，需预防使用抗菌药物[1]。抗菌药物的预防性应用并不能代替严格的消毒、灭菌技术和精湛的无菌操作，也不能代替术中保温和血糖控制等其他预防措施[2]。因医院不同，手术室环境各异，严格按照Ⅰ类清洁切口手术预防用药指征用药，是否会提高患者切口感染率，延长患者住院时间和增加治疗费用[3]，成为手术医师最关注的问题。该研究通过对该院2013年1月—2015年12间收治的Ⅰ类清洁切口手术653例病历分组进行对比分析，探讨在该院的手术条件下，预防性应用抗菌药物对患者切口感染率的影响，验证Ⅰ类清洁切口手术预防用药指征在该院的适用性，为临床合理用药提供参考。报道如下。 (郭宝均)