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目的调查口腔颌面部清洁手术、清洁-污染手术围术期抗菌药物应用及感染情况,评估用药合理性。方法随机性回顾分析西安交通大学口腔医院口腔颌面外科自2010年1月至2012年12月清洁手术住院病历411例,清洁-污染手术住院病历275例,分别从联合用药、用药时间、用药类型、伤口感染、细菌培养等方面进行统计,应用SPSS 18.0软件对数据进行分析。结果清洁手术预防性抗菌药物使用率88.81%,其中单剂用药占38.63%,用药时间小于24小时所占比例为12.33%;清洁-污染手术抗菌药物应用率100%,其感染率高于清洁手术(P=0.039),以清洁-污染肿瘤手术为主(P=0.001),单剂用药伤口感染率高于双联用药(P=0.019)。结论根据抗菌药物应用相关指导原则,清洁手术预防性抗菌药物使用是过度的。清洁-污染肿瘤手术患者是感染好发群体,覆盖革兰氏阳性菌、革兰氏阴性菌的抗菌药物制剂组合优于单剂。
Objective To investigate the application of antibacterials in oral and maxillofacial surgery, clean-and-polluting surgery, and infection, and to evaluate the rationality of drug use. Methods A randomized retrospective analysis of oral and maxillofacial surgery in Stomatology Hospital of Xi’an Jiaotong University from January 2010 to December 2012, 411 cases of clean hospitalized medical records, clean-polluting surgical hospitalized cases of 275 cases, respectively, from the combination of medication, medication time, type of medication , Wound infection, bacterial culture and other aspects of statistics, the application of SPSS 18.0 software for data analysis. Results The use rate of preventive antibacterials in clean operation was 88.81%, of which 38.63% was single dose and 12.33% in less than 24 hours. The rate of application of clean antibacterials was 100%, which was higher than that of clean operation (P = 0.039). The majority of cases were clean-contaminated tumor surgery (P = 0.001). The single-dose wound infection rate was higher than that of double-drug therapy (P = 0.019). Conclusion According to the guidelines for the use of antimicrobial agents, the use of prophylactic antibacterials for clean surgeries is excessive. Clean-contaminated tumor surgery is a predominant group of patients infected with gram-positive bacteria, Gram-negative bacteria antibacterial agent combination is better than a single dose.