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
中文摘要
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。
Exploring the Effectiveness of Shortening Prophylactic Aantibiotic Duration: Application to Abdominal Total Hysterectomy in A Medical Center in Northern Taiwan
英文摘要
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 deter mine 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 sit e infection rate, visit rate of emergency department within 7 days post discharge, re-hospitalization rate within 14 days post di scharge, 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 t he 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 operatio n improved from 0% to 83.2%; (b) postoperative febrile morbidity rate was 1.7 and 6.5 for pre- and post-test group respec﹪ ﹪ tively, but the difference did not reach statistical significance; (c) surgical site infection rate was 0.8 and 1.9 for pre- and p﹪ ﹪ ost-test group, respectively, while the difference was without statistical significance; (d) the visit rate of emergency departmen t within 7 days post discharge was 0.8 and 0.9 for pre- and post-test group, respectively﹪ ﹪ ； it did not show statistical signif icance; (e) No patients in either group was re-hospitalized within 14 days post discharge; (f) the average of length of hospital s tay 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 sit e infection rate. The study would also help establishing practical models for the empirical use and evaluation of the use of pro phylactic antibiotics.
