【作者】 胡蓉；

【导师】 邱明丰； 刘皋林；

【作者基本信息】 上海交通大学 ， 制药工程（专业学位）， 2012， 硕士

【摘要】 我国抗菌药物滥用及细菌耐药日益严重，特别在围术期抗菌药物使用方面常存在不规范、不合理现象。本课题旨在通过临床药师干预围术期抗菌药物应用的实践研究，探索先进的临床药学的工作模式，通过对干预前后的围术期抗菌药物应用合理性的对比分析，评价临床药师干预围术期抗菌药物应用的效果，同时找出问题，为制定针对性的整治措施提供决策依据。通过临床药师加强用药宣教，实施实时干预、回顾性干预、阶段性重点干预等多种举措，行政职能科室考核等措施进行干预。干预结果通过抽取样本医院2011年1-6月（干预前组）1294例和2012年1-6月（干预后组）1360例围手术期患者病例，进行各项抗菌药物应用合理性评价。结果发现在临床药师的干预下，Ⅰ类切口手术抗菌药物使用比例由69.3%降至32.6%；各类药物的使用频次来看，第一代头孢菌素由11.86%增至28.85%，第二代头孢菌素由22.12%增至43.12%，第三代头孢菌素由22.48%降至8.20%，头孢噻吩、头孢硫脒被头孢唑啉和头孢拉定取代，在品种选用方面有了很大的提高，种类的选择更趋合理。此外联合用药的比例较干预前下降16.71％，干预效果显著。给药时间方面，干预后术前0.5～2h应用抗菌药物比例由73.1％提高到97.2％，术前＞2h应用及术前未用术后应用分别由19.3％和7.6％下降至1.6％和1.2％，平均用药时间由4.3d下降为1.7d。抗菌药物总费用占总住院费用比例下降了4.35％，总药品费用占总住院费用比例下降了9.73％。各项指标均有明显提高，P＜0.05，差异均有统计学意义。本研究显示，临床药师干预围术期抗菌药物应用的实践是可行的和有效的，使围术期预防性应用抗菌药物的合理性得到显著提高，降低了患者的住院费用。同时，也为临床药师参与临床合理用药，与临床医师建立起良好的关系，推动合理用药步伐提供了一套行之有效的方法，值得推广。通过研究也发现，目前围术期应用抗菌药物还存在着一些不足之处，如存在无适应证用抗菌药物、术前给药时机不合理、术后用药过长等现象，需要进一步改进，这也是临床药师以后干预围术期应用抗菌药物工作的重点。更多还原

【Abstract】 To evaluate clinical pharmacist intervening perioperative prophylacticapplication of antibiotics. A sample of hospital in20111-6months (beforeintervention group) in1294cases and20121-6months (intervention group) in1360patients were compared with the reasonability of perioperative prophylactic use ofantibiotics. It is found that after the clinical pharmacist ’s intervention, useantibacterial drug in type one incision operation decreased from69.3%to32.6%; Usefrequency of various types showed, first generation cephalosporins increased from11.86%to28.85%, second generation cephalosporins increased from22.12%to43.12%and third generation cephalosporins decreased from22.48%to8.20%.Cefoxitin, cefathiamidine were relaced by cefazolin and cefradine. Selecting varietieshas been greatly improved and reasonable. In addition, it’s high efficiency in controlof combination use drugs.The ratio decreased16.71%before intervention.Afrerintervention,use of antibacterial drug ratio before0.5～2h operation increased from73.1%to97.2%, use of antibacterial drug ratio above2h before operation wasrespectively decreased from19.3%to1.6%. Without use preoperative but usepostoperative of antibacterial drug ratio decreased from7.6%to1.2%.The averagetreatment time was decreased from4.3d to1.7d. Antibacterial drug total cost ofhospitalization decreased4.35%in total drug costs.The total cost of hospitalizationdecreased9.73%. The differences were statistical significances(p<0.05).This study showed, clinical pharmacist’ intervention of perioperative applicationof antibiotics in practice is feasible and effective.The perioperative prophylactic use ofantibacterials became rational significantly and reduced the patient’s hospitalizationexpenses. At the same time,it is a effective method for clinical pharmacists’sparticipation in rational use of drugs, establish a good relationship and promoterational drug use pace. It is worth popularizing.The study also found some shortcomings, such as use of antibacterial drug noindications of antibacterial drug, preoperative administration time unreasonable andlong postoperative medication.These need to be further improved and also a clinicalpharmacist intervention after perioperative preventive antimicrobial application infuture.更多还原