付家甫,董春娟,冯智勇
FU Jiafu,DONG Chunjian,FENG Zhiyong

• 1:广东省广州市花都区第二人民医院
• 2:中铁港航集团第二工程有限公司职工医院
• 3:广东省清远市佛冈县人民医院

摘要(Abstract)：

目的评价医院等级评审对新农合患者Ⅰ类切口预防应用抗菌药物的影响。方法分别抽取不同时间段新农合患者Ⅰ类手术切口病历204份(2012-01~04)和193份(2013-05~2014-06)作为评审前后数据资料,对比分析医院等级评审对新农合患者Ⅰ类切口预防应用抗菌药物的影响。结果医院等级评审后,本院新农合患者Ⅰ类切口预防使用抗菌药物情况较评审前得到明显改善。抗菌药物使用率由评审前100%降至45.08%,抗菌药物联用比例由53.92%降为0,给药时机合理率由61.76%上升至93.10%,给药指征合理率由70.10%上升至94.25%,药物选择合理率由71.08%上升至93.10%,使用疗程合理率由62.75%上升至88.50%,具有显著性统计学意义(P<0.05)。结论医院等级评审加强医院抗菌药物应用的管理,规范新型农村合作医疗的合理用药。
OBJECTIVE To evaluate the impact of hospital grade assessment on antibiotics prophylaxis in type Ⅰ incision surgery under the New Rural Cooperative Medical System. METHODS To extract the different time period medicine records which underwent type I incision surgery under the New Rural Cooperative Medical System. 204 medical records( January 2012-April 2013) was before hospital grade assessment and 193 medical records( May 2013-June 2014) was after hospital grade assessment were compared. The impact of hospital grade assessment to antibiotics prophylaxis in type Ⅰ incision surgery under the New Rural Cooperative Medical System was analyzed. RESULTS After hospital grade assessment,the antibiotics prophylaxis for type Ⅰ incision surgery under the New Rural Cooperative Medical System has been obviously improved than hospital grade before the review. The usage of antimicrobial drugs was from 100% to 45. 08%,the antibacterial drug combination was reduced from 53. 92% to 0,the reasonable rate of delivery time increased from 61. 75% to 93. 10%,the reasonable rate of drug indication increased from 70. 10% to 94. 25%,the reasonable rate for the choice of the drug increased from 71. 08% to 93. 10%,the reasonable rate of treatment course increased from 62. 75% to 88. 50%.There is significant difference between the 2 groups( P < 0. 05). CONCLUSION Hospital grade assessment is beneficial to standardize the application of antimicrobial drugs,and can improve the rational drug application under the New Rural Cooperative Medical System.

关键词(KeyWords)： 医院评审;新农合;抗菌药物;Ⅰ类切口
hospital grade assessment;New Rural Cooperative Medical System;antibiotics;type Ⅰ incision surgery

Abstract:

Keywords:

基金项目(Foundation): 广州市花都区科技计划项目(14-HDWS-65)

作者(Author): 付家甫,董春娟,冯智勇
FU Jiafu,DONG Chunjian,FENG Zhiyong

参考文献(References)：

• [1]牛晓辉.新农合住院费用的分析及异常值筛选方法研究[D].武汉:华中科技大学,2012,33-34.
• [2]Bratzler DW,Dellinger EP,Olsen KM,et al.Clinical practice guidelines for antimicrobial prophylaxis in surgery[J].Am J Health Syst Pharm,2013,70(3):195-283.
• [3]Martindale RG,Deveney CW.Preoperative risk reduction:strategies to optimize outcomes[J].Surg Clin North Am,2013,93(5):1041-1055.
• [4]陈莉,谭光明,黄锐,等.河南省某县医院和乡镇卫生院合理用药现状分析[J].医药导报,2011,30(7):965-967.
• [5]卫生部医政司.国家抗微生物治疗指南[M].北京:人民卫生出版社。2012:49-50.
• [6]中华医学会外科学分会,中华外科杂志编辑委员会.围手术期预防应用抗菌药物指南[J].中华外科杂志,2006,44(23):1594.
• [7]卫生部,国家中医药管理局.抗菌药物临床应用指导原则[S].2004.