目的 分析2017-2019年天津市第四中心醫(yī)院骨科Ⅰ類(lèi)切口圍手術(shù)期預(yù)防使用抗菌藥物的合理性。方法 收取天津市第四中心醫(yī)院骨科2017-2019年Ⅰ類(lèi)切口手術(shù)患者1 298例為研究對(duì)象，對(duì)圍手術(shù)期抗菌藥物的適應(yīng)癥、品種選擇、給藥時(shí)機(jī)、用藥療程、聯(lián)合用藥情況進(jìn)行分析。結(jié)果 選取的Ⅰ類(lèi)切口手術(shù)患者，使用抗菌藥物的患者有753例（58.01%），其中使用率較高的為髖關(guān)節(jié)置換術(shù)（100.00%）、膝關(guān)節(jié)置換術(shù)（100.00%）、骨折切開(kāi)復(fù)位內(nèi)固定術(shù)（82.90%）、其他（50.53%）、使用率較低的為關(guān)節(jié)鏡清理術(shù)（4.76%）、骨折切開(kāi)復(fù)位內(nèi)固定取出術(shù)（4.29%）、皮膚和皮下組織手術(shù)（0.94%）?？咕幬锲贩N選擇使用率最高的為頭孢唑啉，占比為84.33%；次之為克林霉素，占比為11.69%。術(shù)前0.5~1 h開(kāi)始預(yù)防使用抗菌藥物的有743例，占98.67%，用藥療程≤ 24 h的患者有638例，占84.73%；無(wú)指征延長(zhǎng)用藥的有55例，占7.30%。聯(lián)合用藥病歷有1例，占比0.13%，無(wú)聯(lián)合用藥指征。結(jié)論 天津市第四中心醫(yī)院骨科Ⅰ類(lèi)切口抗菌藥物的使用仍存在不合理情況，應(yīng)多部門(mén)加強(qiáng)科學(xué)化管理，進(jìn)一步促進(jìn)圍手術(shù)期抗菌藥物的合理使用。

Objective To analyze the rationality of prophylactic use of antibiotics in perioperative period of type I incision in Orthopedics Department of Tianjin 4th Centre Hospital from 2017 to 2019. Methods Medical records (1 298 cases) having surgery with type I incision from 2017 to 2019 in Department of Orthopaedics, Tianjin 4th Centre Hospital were selected, and indication, variety, time of administration, course of treatment and combination of antibiotics in perioperative period were analyzed. Results 753 Patients (58.01%) with type I incision were selected and treated with antibiotics, among them, hip arthroplasty (100.00%), knee arthroplasty (100.00%), open reduction and internal fixation of fracture (82.90%), other (50.53%), arthroscopic debridement (4.76%), open reduction and internal fixation of fracture (4.29%), skin and subcutaneous tissue operation (0.94%). The highest use rate of antibiotics was cefazolin, accounting for 84.33%, followed by clindamycin, with the application rate of 11.69%. The antibiotics were used between 0.5-1 h before surgery in 743 cases with the application rate of 98.67%.The course of treatment of antibiotics was less than 24 h in 638 cases (84.73%), there were 55 patients (7.30%) who did not have any indication for prolonged antibiotics. There was 1 case (0.13%) with combined of antibiotics, and was no indication of combined medication. Conclusion The rational use of type I incision antibiotics still exists in Department of Orthopedics Surgery of Tianjin 4th Centre Hospital. Scientific management should be strengthened in many departments to promote the rational use of antibiotics in perioperative period.

R978.1