【摘要】 目的 建立手足外科围术期抗菌药物预防使用的管理模式。方法 临床药师参与1例拇指不全离断男性患者因术前不合理用药感染破伤风的诊治，以循证医学证据为基础，参考国内外抗感染诊疗指南、指导原则等，结合手足外科围术期用药存在的问题制订抗菌药物临床药径，分析临床药径干预前后1年的应用效果。结果 临床药径干预1年后，手足外科围术期抗菌药物用药频度降幅为31.42%；预防疗程、用法用量、给药时机的合理性均显著提升（P <0.05）；对58例手指完全或不全离断出院患者的随访结果显示，术后1年均未发生破伤风或相关感染。结论 基于临床药径的药学管理方案可促进手足外科围术期抗菌药物的安全、合理应用。更多还原

【Abstract】 Objective To establish a management model for the prophylactic use of antibiotics during the perioperative period of hand and foot surgery.MethodsA clinical pharmacist participated in the diagnosis and treatment of a male patient with incomplete amputation of the thumb who was infected with tetanus due to improper preoperative medication. Based on evidence-based medical evidence,the clinical pharmacist referred to domestic and foreign anti-infection diagnosis and treatment guidelines,guiding principles,and combined the problems of preoperative medication in hand and foot surgery to develop clinical medication paths for antibiotics. The application effect of the clinical medication path before and after one year of implementation was analyzed.ResultsAfter one year of the implementation of the clinical medication path,the defined daily doses(DDDs) decreased by 31. 42% during the perioperative period of hand and foot surgery,the rationality of preventive treatment courses,usage and dosage,and administration timing were significantly improved(P < 0. 05). The follow-up results of 58 discharged patients with complete or incomplete finger amputation showed that no tetanus or related infections occurred within one year after surgery.ConclusionA pharmaceutical management plan based on the clinical medication path can promote the safe and reasonable use of antibiotics during the perioperative period of hand and foot surgery.更多还原