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題 名 | 醫學中心及區域醫院清淨手術預防性抗生素使用之分析=Prophylactic Antibiotic Usage for Clean Wound Surgeries at Regional Hospitals and Medical Centers in Taiwan |
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作 者 | 張上淳; | 書刊名 | 院內感染控制雜誌 |
卷 期 | 11:6 2001.12[民90.12] |
頁 次 | 頁341-354 |
分類號 | 418.281 |
關鍵詞 | 清淨傷口手術; 手術預防性抗生素; 醫學中心; 區域醫院; Clean wound surgery; Surgical prophylactic antibiotics; Medical center; Regional hospital; |
語 文 | 中文(Chinese) |
中文摘要 | 各種手術預防性抗生素的使用在歐美國家均有一些建議,在國內的全民健保制度中亦有使用規範,為瞭解國內各醫學中心及區域醫院清淨手術預防性抗生素使用情形,並進一步設法改善預防性抗生素的合理使用,因而將健保蟢各醫院於民國89年1月1日至6月30日單純性疝氣手術、甲狀腺切除術、人工髖關節置換術、人工膝關節置換術等四種手術之申報資料加以截取、統計、分析,結果在16家醫學中心和55家區域醫院中各家醫院執行這四種手術之個案數均差異極大(由1例至439例),人工髖關節置換術及人工膝關節置換術各家醫均100%使用抗生素,而單純性疝氣手術與甲狀腺切除術使用抗生素個案所佔比例在各家醫院則有很大的差異(由0%-100%),區域醫院一般比醫學中心使用抗生素比例較高。同一手術中,使用抗生素個案之平均住院天數、平均住院醫療費用及平均藥物花費均高於未使用抗生素之個案;而區域醫院個案之平均住院天數及平均費用並不低於醫學中心個案,甚至部份區域醫院還高於醫學中心級的醫院。各醫院在使用抗生素的種類上差異極大,有些醫院有很高比例之個案單用注射cephalosporin即可(最高者為97.9%),有些醫院卻有很高比例使用注射cephalosporin加口服cephalosporin或注射cephalosporin加aminoglycoside或注射cephalosporin加aminoglycoside再加口服cephalosporin(後者最高比例之醫院為100%),此現象在不同手術、不同等級之醫院均有同樣之情形。此外,各醫院使用抗生素個案之平均抗生素花費差異也是極大(由142元至6,733元)。這些資料經整理分析後均已回饋給各家醫院,希望各醫院能自行評估、比較,並進一步檢討改善,也希望經由此資料的回饋配合其他措施,使得個醫院手術預防性抗生素之使用能愈來俞合理。 |
英文摘要 | There are guidelines or consensus for the surgical antibiotic prophylaxis in many Western countries. The National Health Insurance in Taiwan also provides regulations for the use of prophylactic antibiotics by the surgeons. We collected and analyzed data regarding the surgical antibiotic prophylaxis for simple herniorrhaphy, thyroidectomy, total hip replacement, and total knee replacement from the National Health Insurance Bureau. The data obtained covered all 16 Medical Centers (hospitals with qualified teaching, equipment, and services, as evaluated by the hospital accereditation committee sponsored by the Department of health) and 55 Regional Hospitals over the period between January 1, 2000 and June 30, 2000. The study revealed that the number of cases for each type of surgery performed at each hospital varied widely, from 1 to 439 cases. All patients received prophylactic antibiotics for the total hip or knee replacement. However, for simple herniorrhaphy and thyroidectomy, the percentage of patients who were given the antibiotics varied from 0 to 100% among either the Medical Centers or the Regional Hospitals. For each type of surgery, the mean values of hospitalization days, the hospitalization cost, and the cost of medications were higher for those who received prophylactic antibiotics than those who did not. These costs could be higher at Regional Hospitals than at the medical Centers. The antibiotic regimens employed also varied greatly for all types of surgeries among hospitals. Some hospitals had a high proportion of patients receiving only the intravenous (IV) cephalosporin, some and high proportions of patients given IV cephalosporin plus oral cephalosporin, or IV cephalosporin plus an IV aminoglycoside, or an IV cephalosporin plus aminoglycoside plus oral cephalosporin. The mean cost of prophylactic antibiotics varied from NT 142 to NT 6,933. After the analysis, all hospitals were informed of the data concerning the national averages and ranges, along with their own. We hope this data feedback may help surgeons in each of theses hospitals to a more rational use of surgical prophylactic antibiotics. |
本系統中英文摘要資訊取自各篇刊載內容。