临床路径干预对髋关节置换术预防用抗菌药物的影响

Effect of clinical pathway on antimicrobial prophylaxis in patients with hip joint replacement

摘要:

目的了解实施临床路径（CP）前后，髋关节置换术患者围手术期预防应用抗菌药物情况，为临床提供合理、有效的管理路径。方法 对某院2008年1月—2011年12月间120例髋关节手术患者围手术期预防使用抗菌药物情况进行回顾性调查。其中2008年1月—2009年12月间60例患者设为干预前组，未采取CP治疗方案；2010年1月—2011年12月间60例患者设为干预后组，执行CP治疗方案。结果实施CP后，术前0.5～2 h使用抗菌药物率（78.33%，47/60）和术后预防使用抗菌药物时间≤5 d的比率（91.67%，55/60）显著高于实施CP前（分别为31.67%，19/60；5.00%，3/60），差异有统计学意义（均P＜0.05）；用药品种，由居前3位的头孢哌酮/舒巴坦、头孢匹胺、头孢他啶更改为头孢唑林、头孢呋辛、克林霉素；平均用药时间、平均住院时间及每日抗菌药物费用分别由（13.25±1.69）d、（17.55±1.60）d、（193.22±34.70）元降至（4.12±0.87）d、（7.83±1.36）d、（54.03±9.98）元，差异均有统计学意义（均P＜0.01）。结论 CP的实施规范了髋关节置换术围手术期的预防用药，缩短了住院时间，降低了药物费用。

Abstract:

ObjectiveTo investigate the perioperative antimicrobial prophylaxis in patients with hip replacement before and after implementing clinical pathway (CP), so as to provide rational and effective clinical management path.MethodsPerioperative antimicrobial prophylaxis in 120 patients with hip replacement in a hospital between January 2008 and December 2011 was surveyed retrospectively. Sixty patients without implementing CP between January 2008 and December 2009 were as preintervention group, and 60 patients with CP between January 2010 and December 2011 were as postintervention group.ResultsThe rate of antimicrobial used 0.5-2 hours before operation and duration of postantimcrobial prophylaxis≤5 days in postintervention group was significantly higher than that of preintervention group respectively (78.33%［47/60］ vs 31.67%［19/60］,P＜0.05；91.67% ［55/60］ vs 5.00%［3/60］，P＜0.05）; The top three used antimicrobial agents in preintervention group were cefoperazone/sulbactam, cefpiramide, and ceftazidime, which were replaced by cefazolin, cefuroxime, and clindamycin in postintervention group; the average duration of antimicrobial use, average length of hospital stay and daily expense of antimicrobial agents decreased from (13.25±1.69) days, (17.55±1.60) days,and(193.22±34.70) yuan in preintervention group to (4.12±0.87) days, (7.83±1.36) days，and (54.03±9.98) yuan in postintervention group respectively, the difference between two groups was statistically significant（all P＜0.01). ConclusionThe implementation of CP can standardize preventive perioperative antimicrobial use in hip replacement patients, shorten the length of hospital stay,and reduce antimicrobial expense.