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目的探讨监测—培训—计划(MTP)干预模式对骨外科手术预防使用抗菌药物的效果,为临床合理使用抗菌药物提供依据。方法调取2015年4~9月(干预前)、2015年10月-2016年2月(干预后)医院骨外科手术治疗患者病历,分别纳入干预前组(n=112)和干预后组(n=118),对干预前、后的预防使用抗菌药物评价指标进行比较。结果经过综合干预,骨科预防用药率从85.72%下降至43.22%,抗菌药物选用合理率从22.91%提高到93.87%,给药时机恰当率从25.0%上升到了49.01%,预防用药时间从(5.3±2.1)d缩短至(2.1±1.2)d,抗菌药物使用强度(AUD)由84.13下降到41.21,抗菌药物联合使用率由30.21%下降到7.84%,干预前后比较各组间均显著差异有统计学意义(P<0.05);平均住院时间和平均住院药费均明显下降。结论对骨外科手术预防使用抗菌药物实施综合干预,可有效提高临床抗菌药物使用的合理性,降低抗菌药物使用强度,保障患者围术期预防用药合理、安全,控制住院患者不合理费用的上升。
Objective To explore the effect of monitoring-training-planning (MTP) intervention model on preventing the use of antibacterial drugs in bone surgery, and to provide basis for clinical use of antibacterials. Methods The medical records of patients undergoing orthopedic surgery from April 2015 to September 2015 (before intervention) and from October 2015 to February 2016 (after intervention) were enrolled in the intervention group (n = 112) and intervention group n = 118). The evaluation indexes of antimicrobial agents before and after intervention were compared. Results After comprehensive intervention, the prophylactic rate of orthopedics dropped from 85.72% to 43.22%, the rate of rational use of antibacterials increased from 22.91% to 93.87%, the correct timing of administration increased from 25.0% to 49.01% 2.1) d to (2.1 ± 1.2) d, the strength of antimicrobial agents (AUD) decreased from 84.13 to 41.21, and the combined use of antimicrobial agents decreased from 30.21% to 7.84%. Significant differences among the groups before and after intervention were statistically significant Significance (P <0.05); average length of hospital stay and average hospitalization costs were significantly decreased. Conclusion The implementation of comprehensive intervention in the prevention of the use of antimicrobial agents in orthopedic surgery can effectively improve the rationality of clinical use of antimicrobial agents, reduce the intensity of antimicrobial use, and ensure reasonable and safe perioperative prophylaxis and increase of unreasonable costs of inpatients.