对比分析《抗菌药物临床应用规范及管理实施细则》实施前后骨折手术患者抗菌药物预防使用情况。

回顾性分析本院骨三科2010年1月至2014年12月共348例四肢闭合性骨折Ⅰ类切口手术患者使用的抗菌药物种类、疗程、费用、抗菌药物费用占住院总费用比例、术后感染率及住院时间。

实施前组与实施后组患者的年龄、性别、上下肢分布组间差异均无统计学意义。实施前组患者使用非限制性抗菌药物及限制性抗菌药物分别为20例和151例，实施后组患者使用非限制性抗菌药物及限制性抗菌药物分别为165例和12例，组间差异患者有统计学意义（χ² = 232.15、P < 0.001）。实施前组患者抗菌药物疗程、抗菌药物费用和抗菌药物费用占住院总费用比例分别为（4.006 ± 2.279）d、（839.180 ± 678.177）元和（4.674 ± 3.727）%；实施后组患者抗菌药物疗程、抗菌药物费用和抗菌药物费用占住院总费用比例分别为（1.492 ± 0.948）d、（58.081 ± 175.449）元、（0.239 ± 0.546）%。组间差异均具有统计学意义（Z =-12.998、-14.746、-15.270，P均< 0.001）。实施前组患者术后感染率和平均住院天数分别为2.339%和（20.440 ± 16.838）d；实施后组患者术后感染率和平均住院天数分别为为1.695%和（20.050 ± 13.922）d，组间差异均无统计学意义。

实施《抗菌药物临床应用规范及管理实施细则》后，本院骨科预防性使用抗菌药物日趋合理，在未增加感染率及平均住院天数的前提下，有效降低了抗菌药物级别及费用，并缩短了抗菌药物使用疗程。

To analyse the prevention usage situation of the antibiotic application in fracture surgery before and after applying the "Guideline & Rules of antibiotic clinical application" in our hospital.

The clinical data of 348 patients who suffered closed fractures of the extremities with type Ⅰ incision in Department of Orthopaedic Ward 3 in our hospital between January 2010 and December 2014 were collected. The course of treatment, expenses, pharmaceutical proportion of antibiotics, postoperative infective rate and the length of stay (LOS) were analyzed, retrospectively.

There was no significant difference in the age, the sex and the disposition of limbs between the patients before the guideline & rules was implemented (GBI group) and after the guideline & rules was implemented (GAI group). The cases who applying unrestricted antibiotics and restricted antibiotics in the GBI were 20 and 151, respectively, while the cases in the GAI were 165 and 12, respectively, with significant differences (χ² = 232.15, P < 0.001). The course, the expenses and the pharmaceutical proportion of antibiotics in the GBI were (4.006 ± 2.279) days, (839.180 ± 678.177) yuan and (4.674 ± 3.727)%, respectively; while the number in the GAI were (1.492 ± 0.948) days, (58.081 ± 175.449) yuan and (0.239 ± 0.546)%, respectively. There were significant differences in the course, the expenses and the pharmaceutical proportion between patients in GBI group and GAI group (Z =-12.998, -14.746 and -15.270; all P < 0.001). The postoperative infective rate and the average LOA in the GBI were 2.339% and (20.440 ± 16.838) days, respectively; while the number in the GAI were 1.695% and (20.050 ± 13.922) days, respectively. There was no significant difference in the postoperative infective rate and the average LOA between patients in GBI group and GAI group (all P > 0.05).

After the implementation of the "Guideline & Rules of antibiotic clinical application" , the preventive use of antibiotic of our hospital had become more reasonable. The drug grade and the expenses had been descended while the course had been shorted significantly without increasing the infective rate and the average LOA.