何艳玲
HE Yanling

• 1:广州市妇女儿童医疗中心

摘要(Abstract)：

目的分析本院剖宫产手术围手术期抗菌药物的使用情况,评价用药合理性,进一步指导临床合理应用抗菌药物。方法查阅2013-07~12期间,900例行剖宫产手术病例,对其预防性使用抗菌药物情况进行回顾性分析。结果 900例剖宫产手术抗菌药物使用率达99.7%。抗菌药物共计8种,其中头孢呋辛、头孢孟多酯使用频率最高。术前0.5~2 h用药7例(0.8%),术中结扎脐带后给药621例(69.3%),术后用药242例(27.1%)。术后抗菌药物使用疗程,小于24 h者567例(63.3%),24~48 h之间者203例(22.7%)。抗菌药物单用865例(96.1%),二联用药31例(3.4%)。不合理用药情况共194例次(21.7%),其中出现频率最高的是术后用药疗程过长126例次(64.9%)、选药档次过高40例次(20.6%)。结论本院剖宫产手术围手术期预防使用抗菌药物存在用药时间长、用药档次偏高等问题,需加强监管。
OBJECTIVE To investigate the application of antimicrobial prophylaxis in cesarean section,and promote the rational use of antibiotics. METHODS Retrospective investigation and analysis were conducted in 900 cases of cesarean section which selected from July to September in 2013.RESULTS Among 900 cases of cesarean section,the use rate of antibiotics was 99.7%. 8 kinds of antibiotics were counted,in which cefuroxime and cefamandole sodium had the highest use rate. Antibiotics were given 0.5-2 h before operation in 7( 0.8%) cases,621( 69.3%) were given after the umbilical cord be clamped and 242( 27.1%) were( 63.3%),and during 24-48 h in 203 cases( 22. 7%). 865 cases( 96. 1%) received single antibiotic and 31 cases( 3. 4%) received two-drug combination use. 194 cases( 21.7%) contained irrational use of antibiotics,in which the medication for a long time after operation( 126 cases,64. 9%) and high-grade drugs( 40 cases,20. 6%) had the highest use rate. CONCLUSION The perioperative use of prophylactic antibiotics for patients undergoing cesarean section in the hospital is rational,but the medication for a long time after operation,high-grade drugs and other issues need to be improved.

关键词(KeyWords)： 剖宫产;抗菌药物;预防;合理用药
cesarean section;antibiotics;prophylactic use;rational use of drugs

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 何艳玲
HE Yanling

参考文献(References)：

• [1]中华人民共和国卫生部.国家中医药管理局、总后勤部.抗菌药物临床应用指导原则[S].2014.
• [2]中华人民共和国卫生部.剖宫产手术围手术期预防用抗菌药物管理实施细则(征求意见稿)[S].2009,11,24.
• [3]Morisaki N,et al.Maternal and institutional characteristics associated with the administration of prophylactic antibiotics for caesarean section:a secondary analysis of the World Health Organization Multicountry Survey on Maternal and Newborn Health[J].BJOG,2014,121 Suppl 1:66-75.doi:10.1111/1471-0528.12632.
• [4]唐荣,罗阳.4161例剖宫产围手术期预防性使用抗菌药物调查分析[J].中国现代药物应用,2012,6(17):6-8.
• [5]梁建敏.1650例剖宫产围术期抗菌药物应用分析[J].中国药业,2014,23(5):52-53.
• [6]肖艳萍.500例剖宫产围手术期抗感染用药分析[J].中国医院用药评价与分析,2006,6(4):230-231.
• [7]王克玲.探讨剖宫产术后切口感染相关因素分析[J].中外健康文摘,2014,25:51-51.
• [8]ACOG Committee on Practice Bulletins--Gynecology.ACOG practice bulletin No.104:antibiotic prophylaxis for gynecologic procedures.Obstet Gynecol.2009 May;113(5):1180-1189.doi:10.1097/AOG.0b013e3181a6d011.
• [9]Pan Y,Sonn GA,Sin MLY,et al.Electrochemical immunosensor detection of urinary lactoferrin in clinical samples for urinary tract infection diagnosis[J].Biosens Bioelectron,2010,26(2):1011-1014.
• [10]孙淑娟,龚燕.抗菌药物治疗学[M].北京:人民卫生出版社,2008:321-323.
• [11]汤小明.本院剖宫产围术期预防性应用抗菌药物分析评价[J].中国现代药物应用,2012,6(4):82-84.
• [12]张雁,朱海英,张亚芳.妇科围手术期抗菌药物的监督与管理[J].药物流行病学杂志,2006,15(4):239-241.
• [13]Bratzler DW,Dellinger EP,Olsen KM,et al.Clinical practice guidelines for antimicrobial prophylaxis in surgery[J].Surg Infect(Larchmt),2013,14(1):73-156.doi:10.1089/sur.2013.9999.Epub 2013 Mar 5.
• [14]李晓霞,熊伟,张启祥.剖宫产围手术期抗菌药物使用分析及合理性评价[J].药物与临床,2013,10(10):24-28.
• [15]ACOG practice bulletin number 47,October 2003:Prophylactic Antibiotics in Labor and Delivery[J].Obstet Gynecol,2003,102(4):875-882.
• [16]Edwards RK,Clark P,Sistrom CL,et al.Intrapartum antibiotic prophylaxis 1:relative effects of recommended antibiotics on gram-negative pathogens[J].Obstet Gynecol,2002,100(3):534-539.
• [17]Terrone DA,Rinehart BK,Einstein MH,et al.Neonatal sepsis and death caused by resistant Escherichia coli:possible consequences of extended maternal ampicillin administration[J].Am J Obstet Gynecol,1999,180(6 Pt 1):1345-1348.
• [18]Baaqeel H,Baaqeel R.Timing of administration of prophylactic antibiotics for caesarean section:a systematic review and meta-analysis[J].BJOG,2013,120(6):661-669.
• [19]Heesen M,Klhr S,Rossaint R,et al.Concerning the timing of antibiotic administration in women undergoing caesarean section:a systematic review and meta-analysis[J].BMJ Open,2013,3(4).
• [20]张霞,徐红冰,刘牟林,等.233例剖宫产围手术期抗菌药物应用情况分析[J].中国医药导刊,2007,9(5):394.
• [21]章茜.剖宫产术后预防性抗生素应用的疗效分析[J].抗感染药学,2008,5(3):181-182.