目的:了解我院围手术期预防性应用抗菌药物情况,评价应用的合理性。方法:经对我院符合围手术期预防性应用抗菌药物要求的切口愈合良好的234例病历的适应症、用药种类、联合用药、给药方法及给药持续时间进行统计分析。结果:234例病历所涉及围手术期预防用药共计271例次,给药时机及给药持续时间合理225例次(8303％),不合理46例(16.97％)。围手术期抗菌药物使用一代头孢101例(37.27%),广谱青霉素类49例(1808%)、β-内酰胺酶抑制剂40例(14.76%)。其中单用、二联和三联用药分别为206例(88%)、25例(11％)和3例(128%),平均疗程为2.3天。结论:我院抗菌药物使用仍存在不足之处,加强抗菌药物的使用管理,规范围手术期抗菌药物的使用,需通过临床医师、药师及其他医务人员共同参与,提高我院抗菌药物合理使用水平。
Objective To understand the situation and technical level of aeromedical rescue in medical institutions in Qinling-Daba mountainous area. Methods A questionnaire survey was conducted on the staff of medical institutions of the medical consortium of Renmin Hospital of Hubei University of Medicine, located in Qinling-Daba mountainous area between June and September 2023. The basic information and development, demand, and knowledge mastery of aeromedical rescue were investigated. Results A total of 45 medical institutions participated in the research, 500 questionnaires were sent out, and 479 valid questionnaires were recovered, with an effective rate of 95.8%. Among them, there were 7 tertiary hospitals, 23 secondary hospitals, and 15 township health institutions; 11 medical institutions had participated in aeromedical rescue, and 17 hospitals had participated in aerial rescue drills. The survey subjects were mainly from emergency departments and intensive care medicine departments, women, aged>30 and ≤40 years old, undergraduate students, intermediate professional titles, and doctors. Twenty-one medical workers had received formal training in aeromedical rescue skills, 77 had received short-term theoretical and practical training, 123 had participated in short-term simulation exercises, and 93 had participated in aeromedical rescue activities. There was a statistically significant difference among the scores of first aid knowledge, aviation flight knowledge, and aeromedical rescue knowledge (9.34±0.35 vs. 4.65±2.91 vs. 3.28±3.44; F=15.048, P=0.001). There were statistically significant differences between first aid knowledge and aviation flight knowledge, as well as between first aid knowledge and aeromedical rescue knowledge (P<0.05). There was no statistically significant difference between aviation flight knowledge and aeromedical medical rescue knowledge (P>0.05). Conclusion There is an urgent demand for aviation rescue in medical institutions in Qinling-Daba mountainous area, and there is a shortage of professionals, so it is necessary to strengthen the training, rehearsal and practice of aeromedical rescue.
摘要:目的：评价围手术期预防性应用抗菌药物现状及合理性。方法：采用回顾性调查的方法，随机抽查2009年度Ⅰ类切口手术围手术期病案500份，设计外科围手术期预防性应用抗生素调查表，对预防用药的适应证、用药种类、联合用药、给药时机及持续时间进行统计分析。结果：未使用抗生素5例，预防性使用抗生素495例，其中不合理80例（16.00％）。预防性使用抗生素总品规数为540，其中头孢菌素类453例（83.89%），青霉素类（包括加酶抑制剂）26例（4.81%），喹诺酮类44例（8.15%）。选用头孢唑啉钠178例（32.96%）居第一位，头孢替唑钠第二，151例（2796%）。结论：Ⅰ类切口手术患者围手术期预防性使用抗菌药物较为合理，但仍存在用药指征把握不严，抗菌药物的选择、抗菌药物使用时间较长等问题，有待进一步规范化管理。Abstract: Objective: To understand the current application of perioperative preventive antibiotics, and their rationality. Methods: Five hundred perioperative records of patients with incision Ⅰ were randomly chosen and surveyed in 2009. A questionnaire for prophylactic use of antimicrobial was designed. The indication of antimicrobial use, the species, combination, timing and drug duration were analyzed. Results: Our of 500, 495 used antimicrobial and 80 were unreasonable; 540 kinds of antimicrobial were used, included cephalosporin 453 cases (83.89%), penicillin class (including plus enzyme inhibitors) in 26 cases (4.81%), quinolone 44 cases (8.15%). Cefazolin sodium (178 patients, 32.96%) ranked first, second was cefazolin sodium (151, 27.96%). Conclusion: Perioperative use of antimicrobial prophylaxis in patients with incision Ⅰ is reasonable, but standardization management should be strengthened in the indication, species, and duration.
【摘要】 目的 了解围手术期预防性应用抗菌药物的现状并评价其合理性。 方法 采用回顾性调查的方法，随机抽查2009年1-12月500例Ⅰ类切口围手术期患者资料，填写设计的《外科围手术期预防性应用抗菌药物调查表》，对预防用药的适应证、用药种类、联合用药、给药时机及持续时间进行统计分析。 结果 500例中，未使用抗菌药物5例，预防性使用抗菌药物495例，不合理或欠合理80例（16.00%）。预防性使用抗菌药物总例次为540，其中头孢菌素类453例次（83.89%），青霉素类（包括酶抑制剂）26例次（4.81%），喹诺酮类44例次（8.15%），林可酰胺类17例次（3.15%）。头孢唑啉钠使用178例次（32.96%）居第1位，头孢替唑钠使用151例次（27.96%）。 结论 Ⅰ类切口手术围手术期预防性使用抗菌药物较为合理，但仍存在用药指征把握不严，抗菌药物的选择、使用时间较长等问题，有待进一步规范化管理。【Abstract】 Objective To evaluate the prophylactic application of antibiotics during the perioperative period of type I incisions. Methods The clinical data of 500 patients with type I incisions from January to December of 2009 were retrospectively analyzed by self-designed questionnaire survey. The indication of antibiotics usage, choice of antibiotics categories, combination of antibiotics,giving time and length of antibiotics usage were analyzed. Results In 500 patients, only 5 were not given antibiotics, 80 (16%) were given antibiotics unnecessarily. In 540 patients who had underwent the antibiotic administration, 453 (16%) were administrated with cephalosporins, 44 (8.15%) were with fluoroquinolones, 26 (4.81%) were with penicillins, and 17 (3.15%) were with lincomycins. Cefazolin, the most used antibiotics, was given in 178 patients (32.96%)。Ceftezole was given in 151 patients (27.96%). Conclusion The prophylactic application of antibiotics during the perioperative period of type I incisions is basically rational, however, there were also some problems, such as using antibiotics unnecessary, mischoice of antibiotics and using antibiotics too long. Thus, we need management of prophylactic antibiotics usage.
Objective To investigate infertile inpatients hospitalized in Pingjin Hospital in Tianjin from 2008 to 2010, so as to provide baseline data for further research. Methods According to diagnosis criteria of WHO, we collected demographical characteristics, disease cause and cost constitution of infertility inpatients hospitalized in Pingjin Hospital in Tianjin from 2008 to 2010. The data of each patient were input into ACCESS database and SPSS 13.0 was used for statistical analysis. Results a) From 2008 to 2010, there were 1 452 infertile patients from 33 different areas of mainland China, 79.7% of which was from the north of China. b) The mean age was 31.2±4.3 years old. The percentage of patients aged 30 to 34 years accounted for the most (40.3%). Mental laborers (23.3%) were more than physical laborers (7.2%). 36.7% of patients received education from universities and 83.1% of patients had family income ranging from 20,000 yuan to 190,000 yuan. c) The mean age of the first sexual activity was 21.4±2.9 years old. 53.7% of patients had only one sexual partner and most couples had sexual activities twice every week. The mean age of husbands was 32.9±5.5 years old with the highest percentage of 30 to 35 years old (39.2%). The percent of intellectual work of husband was the highest (35.9%). 64.9% of patients had normal semen analysis results and 23.0% never took related examination. d) 29.9% of patients was primary infertility and 70.1% was secondary infertility, of which 57.6% had either induced or medical abortion. The mean duration of infertility was 5.2±3.5 years (range 1 to 21 year). e) 76.3% of infertile patients had pelvic adhesion and 88.6% suffered from tubal disease. Among the tubal infertile patients, 23.6% had uterine disease, 5.2% had ovarian disease, 5.0% had endometriosis, 6.7% had multiple problems, and 4.8% had unexplained infertility. In patients with tubal infertility, the incidence of distal fimbria atresia (45.8%) was higher than that of proximal block (32.9%). 24.7% of patients with fimbria atresia had hydrosalpinx and among of them, 21.1% had no hydrosalpinx. 15.2% had congenital tubal defects. f) The average hospital stay was 10.5 days and the cost was 14 253.3 yuan per person. The percentage of material cost was 29.1% and that of drugs was 18.2%. Conclusion a) The total number of infertile inpatients was 1 452 in gynecology department of Pingjin Hospital of Tianjin from 2008 to 2010. 79.7% of patient was from North China. Most of them were 30 to 34 years old and 44.3% had no job. The percentage of patients had university education and that of low-middle family income was the highest. Sexual activity was relatively traditional. Most husbands were 30 to 35 years old and intellectual workers, and 23.0% of them had never taken an examination of semen analysis. More patients were secondary infertile, and the duration of infertility was 1 to 21 years. b) 76.3% of patients had pelvic adhesion and 88.6% had tubal disease. The incidence of distal tubal fimbria atresia was higher than proximal tubal occlusion. c) The average hospital stay was 10.5 days and the cost was 14 253.3 yuan per person which was further lower than each cycle cost of assisted reproductive technology. The overall costs included materials and drugs (47.3%), which were mainly at patients’ own expense.
Objective To investigate the inpatient’s disease and cost constitution of the Third People’s Hospital of Chengdu in 2009, so as to provide baseline data for further research. Methods The case records of inpatients in the Third People’s Hospital of Chengdu in 2009 were collected, and based on the first diagnose, the diseases were classified according to the International Classification of Diseases (ICD-10). The data including general information of the inpatients, discharge diagnosis and hospitalization expense etc. were rearranged and analyzed using Excel software. Results a) The total number of inpatients was 1 220, and male was more than female. The disease spectrum included 12 categories. b) A total of 1 093 inpatients suffered from the top 3 systematic diseases as follows: trauma and toxicosis, musculoskeletal system and connective tissue disorders, and the factors affecting health and resulting from contact with health care institutions. Except the musculoskeletal system and connective tissue disorders, the other 2 systematic diseases were mostly seen in male rather than in female. c) According to ICD-10, the top 9 diseases of trauma and toxicosis were injuries to the wrist and hand, injuries to the hip and thigh, injuries to the knee and lower leg, injuries to the shoulder and upper arm, injuries to the lower back, lumbar spine and pelvis, injuries to the elbow and forearm, injuries to the thorax, injuries to the neck and injuries to the ankle and foot; the top 4 diseases in musculoskeletal system and connective tissue disorders were dorsopathies, soft tissue disorders, arthrosis, and osteopathies and chondropathies; among the factors affecting health and resulting from contact with health care institutions, removal of fracture fixation device. d) According to ICD-10 (list of three-digit catalogue and four-digit sub-catalogue), the top 5 single diseases in trauma and toxicosis were muscle and tendon injuries of the wrist and hand, intertrochanteric frature, fracture of the femoral neck, fracture of the tibia and fibula, and fracture of the lumbar spine; the top 5 single diseases in musculoskeletal system and connective tissue disorders were lumbar disc herniation, spondylosis, arthrosis of the knee, osteoporosis with pathological fracture, and osteonecrosis. e) The average hospital stay were 23.55 days, and the average cost per capita were 13 073.73 yuan which were constituted by material cost, drug cost including western and Chinese medicines, treatment expenses including blood transfusion fee, operation expenses including anesthetic fee, examination expenses including radiation fee and laboratory fee, bed fee and others. The inpatient costs were mainly at patient’s own expense, nearly a half of those expenses were paid by social security, and public medical care only accounted for less than 3% of the total payment. Conclusion In 2009: a) The male inpatients were mainly the young and middle-aged, and the female were the elderly. The main 3 systematic diseases were trauma and toxicosis, musculoskeletal system and connective tissue disorders, and the factors affecting health and resulting from contact with health care institutions. Except the musculoskeletal system and connective tissue disorders, the other 2 systematic diseases were mostly seen in male rather than in female. b) The top 3 single diseases were lumbar disc herniation, muscle and tendon injuries of the wrist and hand, and intertrochanteric fracture. Except lumbar disc herniation, the other 2 single diseases were mostly seen in male rather than in female. c) The average hospital stay was 23.55 days. The overall costs were mainly constituted by material and drug cost (59.25%), with rationality worthy of attention. d) Inpatient costs were mainly at patient’s own expense or paid by social security, and the proportion of public medical care was low in the payment.
ObjectiveTo understand the current status of nosocomial infections in a municipal medical unit, to find problems in daily monitoring, and to provide the evidence for the prevention and control of nosocomial infection in high-risk groups and procedures. MethodsAccording to the 2013 survey requirements made by the nosocomial infection control center of Chengdu, we made a cross-sectional survey about nosocomial infection among all the inpatients on July 25th, 2013 and statistically analyzed the results. ResultsTotally, 1 301 cases were actually investigated within 1 307 inpatients of the time (the actual investigation rate was 99.54%). The prevalence rate of nosocomial infection was 3.38% (44 cases). The top five departments of infection rate were Respiratory Intensive Care Unit (RICU), Center of Intensive Care Unit (CICU), Department of Neurosurgery, Department of Thoracic Surgery and Department of General Surgery. The main site of infection was respiratory tract, which took possession of 62.25%. In univariate analyses, age≥60, length of hospital stay >2 weeks, invasive operation, history of diabetes, operation, radiotherapy/chemotherapy, utilization of antibiotics were found to be risk factors for infections. Multivariate analysis showed that length of hospital stay (OR=3.115, P=0.001), invasive operation (OR=14.930, P<0.001), diabetes mellitus (OR=2.157, P=0.046), radiotherapy/chemotherapy (OR=7.497, P<0.001) were independent risk factors for nosocomial infections. The utilization rate of antibiotics was 45.73%. Among them, there was 85.21% using single antibiotics, and 82.18% of them were used therapeutically. ConclusionUnderstanding the current status of nosocomial infection in municipal hospitals helps us grasp the key and difficulty of infection control, make out prevention-control measures for high-risk groups and high-risk departments, and guide and supervise its implementation in clinical departments, which points out the direction to further reduce the incidence of nosocomial infection.
【摘要】 目的 了解外科围手术期预防性使用抗菌药物现状，评估其用药合理性。 方法 随机抽取2009年1-12月265例外科手术患者病历，根据《抗菌药物临床应用指导原则》和《卫生部办公厅关于抗菌药物临床应用管理有关问题的通知》对抗菌药物使用进行合理性评价。 结果 265例外科手术患者均使用了抗菌药物，使用率为100%，外科围手术期预防用抗菌药物不合理率为63.89%，存在的主要问题是用药指征过宽、起点过高、手术前预防用药时间不当、术后预防用药时间过长及盲目联合用药。 结论 外科围手术期抗菌药物预防性使用不合理现象突出，应积极开展合理使用抗菌药物培训，加强抗菌药物使用管理，规范围手术期抗菌药物的使用，从而提高外科围手术期抗菌药物使用合理性。【Abstract】 Objective To know the status of prophylactic use of antimicrobial agents in perioperative patients, and to evaluate the medication rationality. Methods The medical records of 265 patients who underwent the surgeries from January to December 2009 were randomly extracted, and the medication rationality was evaluated according to "Guiding Principles of Clinical Use of Antibiotics" and "Notice of Medical Department Office about Antibiotics Clinical practice Management Related Questions". Results All of the 265 perioperative patients were treated with antimicrobial drugs with a utilization rate of 100.00%, and the unreasonable rate of perioperative prophylactic use of antimicrobial agents was 63.89%. The main reasons included over-extended medication indications, high starting points, inappropriate time points of prophylactic medication, long duration of prophylactic medication and unreasonable drug combination. Conclusion The perioperative prophylactic use of antimicrobial agents is clinically unreasonable. It is necessary to carry out training on the rational use of antimicrobial agents to enhance the management of antimicrobial drug use and regulate the use of antimicrobial agents in perioperation.
目的 了解医院感染现患率及危险因素，及时调整医院感染预防控制措施。 方法 医院感染管理专职人员与临床医师共同调查2010年12月15日0：00～24：00所有住院患者，查阅病历和床旁调查相结合，填写统一的现患率调查个案登记表和床旁调查表，对调查结果进行统计分析。 结果 医院感染现患率2.49%；科室主要分布在综合重症监护病房（ICU）和内三科（肿瘤和内分泌专业）；部位主要分布在下呼吸道、泌尿道、血液；导管相关感染有增加趋势，不合理使用抗菌药物问题较突出。 结论 综合ICU和内三科是新津县人民医院的重点科室；下呼吸道、泌尿道、中心静脉置管部位是重点部位；侵袭类操作及不合理使用抗菌药物是危险因素；该院医院感染预防控制工作重点：加强导管相关感染监测，增加耐药菌监测，加强对综合ICU、内三科的管理，加强对侵袭性操作及合理使用抗菌药物的管理，提高病原学送检率。