縮短外科預防性抗生素使用期限之成效探討:以某醫學中心腹式全子宮切除術為例

Exploring the Effectiveness of Shortening Prophylactic Aantibiotic Duration: Application to Abdominal Total Hysterectomy in A Medical Center in Northern Taiwan

曾瑪珊(Ma-Shan Tzeng)

指導教授 ： 施富金

臺北醫學大學/護理學院/護理學研究所/碩士(2003年)

摘要

本研究目的首先在瞭解腹式全子宮切除術（Abdominal Total Hysterectomy, ATH）預防性抗生素使用現況，包括第一劑預防性抗生素注射時間距離劃刀在30分鐘與120分鐘內之達成率，及預防性抗生素使用期限控制在24小時內之達成率，和探討縮短ATH預防性抗生素使用期限，對下列各變項之影響，包括術後熱病症、手術部位感染、出院後七天內因術後合併症至急診就醫、出院後十四天內因術後合併症再住院、平均住院天數、以及預防性抗生素總費用、藥物總費用、醫療總費用等。 本研究採前測－後測比較法，針對北部某一醫學中心接受ATH之病患為研究對象，以立意取樣，利用結構式資料表回顧病歷收集資料，共收案227位（前測組120位，後測組107位）。資料再以描述性統計、卡方檢定及費雪適當性檢定及t檢定分析。結果顯示：縮短預防性抗生素使用期限（1）使預防性抗生素控制於24小時內之達成率由前測組0﹪進步至後測組83.2﹪，提高預防性抗生素使用的正確性；（2）術後熱病症發生率，前後兩組分別為1.7﹪及6.5﹪，未達統計顯著差異；（3）手術部位感染率，前後兩組分別為0.8﹪及1.9﹪，未達統計顯著差異；（4）因術後合併症出院後七天內再至急診就醫率，前後兩組分別為0.8﹪及0.9﹪，未達統計顯著差異；（5）十四天內再住院率，前後兩組均為0.0﹪；（6）病患平均住院天數，前後兩組分別為6.4天及6.3天，未達統計顯著差異；（7）預防性抗生素費用由前測組NT＄480.9降為後測組NT＄367.5（減少NT＄113.4），藥物總費用，由前測組NT＄1,461.9降為後測組NT＄1,191.5（減少NT＄270.4），達統計之顯著差異；醫療平均總費用由前測組NT＄36,995.4降為後測組NT＄36,847.8（減少NT＄147.6），未達統計顯著差異。 本研究結果有助於澄清「長時間注射預防性抗生素可降低術後部位感染」之迷思，可提供婦科及相關科別醫護人員正確使用預防性抗生素之參考，並有助於醫療管理團隊建立正確預防性抗生素臨床使用之評估模式。

關鍵字

腹式全子宮切除術 ； 預防性抗生素 ； 縮短預防性抗生素使用期限 ； 術後熱病症 ； 手術部位感染 ； 平均住院天數 ； 預防性抗生素總費用 ； 住院總醫療費用

並列摘要

The purposes of this study were threefold: (a) to explore the achievement rate of the first dose of prophylactic antibiotic used within 30 and 120 minutes preoperatively in the patients who underwent Abdominal Total Hysterectomy (ATH); (b) to determine the achievement rate of prophylactic antibiotic used within 24 hours after beginning of operation; and (c) to compare the changes made by shortening the duration of prophylactic antibiotic, including postoperative febrile morbidity rate, surgical site infection rate, visit rate of emergency department within 7 days post discharge, re-hospitalization rate within 14 days post discharge, cost related to antibiotic use, total drug expenditure and total medical expenses. A total of 227 patients (120 in the pre-test group, and 107 in the post-test group) who underwent ATH in a Medical Center in the Northern Taiwan were recruited in this study. The data were collected by structured chart review. Descriptive statistic, Chi-square test, Fisher’s exact test and t-test were used for statistical analysis. The findings of the study were (a) the achievement rate of using prophylactic antibiotic dosage within 24 hours of the operation improved from 0% to 83.2%; (b) postoperative febrile morbidity rate was 1.7﹪and 6.5﹪ for pre- and post-test group respectively, but the difference did not reach statistical significance; (c) surgical site infection rate was 0.8﹪and 1.9﹪for pre- and post-test group, respectively, while the difference was without statistical significance; (d) the visit rate of emergency department within 7 days post discharge was 0.8﹪and 0.9﹪for pre- and post-test group, respectively；it did not show statistical significance; (e) No patients in either group was re-hospitalized within 14 days post discharge; (f) the average of length of hospital stay was 6.4 days and 6.3 days and this is without statistically significance; (g) the cost of antibiotic use reduced from NT$ 480.9 to NT$367.5 and total drug expenditure reduced from NT$1461.9 to NT$1191.5, both showed statistical significance; and (h) the average total medical expense reduced from NT$36,995.4 to NT$36,847.8, but this was without statistical significance. The results of this study clarified the myth that long-term use of antibiotic prophylaxis would reduce postoperative surgical site infection rate. The study would also help establishing practical models for the empirical use and evaluation of the use of prophylactic antibiotics.

並列關鍵字

abdominal total hysterectomy ； antibiotic prophylaxis ； shortening the use of antibiotic prophylaxis ； postoperative febrile morbidity rate ； surgical site infection rate ； average of length of hospital stay ； prophylaxis cost ； total medical expenses

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