目的:评价产科胎膜早破(PROM)患者B族链球菌(GBS)感染预防药物临床路径(以下简称"临床药径")的应用效果。方法:针对某院产科PROM患者GBS感染的抗菌药物预防性使用中存在的问题，制定了PROM患者GBS感染预防临床药径，分为足月PROM、≥34 w未足月PROM(PPROM)、<34 w PPROM，"医药护"三师联动对PROM患者GBS感染预防进行管理。对比临床药径实施前后PROM患者GBS感染预防抗菌药物使用的合理性、抗菌药物使用强度、药物经济学(住院时间、抗菌药物费用)等指标。结果:临床药径实施后PROM患者GBS感染预防用药的药物选择、给药时机、疗程合理率均有显著升高(P<0。05)。足月PROM、≥34 w PPROM患者的用药疗程均较前显著缩短(P<0。05)。足月PROM平均住院时间缩短0。7 d，平均抗菌药物费用下降8。86元/人，与实施前比较，差异有统计学意义(P<0。05)。抗菌药物使用强度呈明显下降趋势，最低下降至9。78DDD。结论:建立产科PROM患者GBS感染预防临床药径切实可行，有效降低了医疗成本、住院天数及抗菌药物使用强度，在保障围产期PROM患者母婴安全中发挥积极作用。
Practice and Evaluation of Medicine Clinical Pathways for Preventing Group B Streptococcus Infection in Obstetric Patients with Premature Rup-ture of Membrane
Objective:To establish medicine clinical pathways for preventing group B streptococcal(GBS)infection in patients with premature rupture of membrane(PROM)and evaluate their application ef-fects.Methods:In view of the problems existing in the preventive use of antibiotics for GBS infection in obstetric patients with PPOM,corresponding clinical medicine pathways were formulated,including full-term PROM,≥34 w preterm PROM(PPROM)and<34 w PPROM.Doctors,pharmacists and nurses worked to-gether to prevent and manage GBS infection in patients with PROM.The rationality of prophylactic use of antibiotics,the antibiotics use density,the length of hospital stay and the cost of antibiotics were compared before and after clinical medicine pathway management.Results:The rational rate of drug selection,timing of administration and duration of prophylactic drugs for GBS infection in PROM patients were significantly increased after the clinical medicine pathway application(P<0.05).The durations of antibiotics in patients with full-term PROM or≥34 w PPROM were significantly shortened(P<0.05).The average length of hos-pital stay in full-term PROM was shortened by 0.7 d(P<0.05).The average cost of antibacterial drugs in full-term PROM decreased by 8.86 yuan(P<0.05).The antibiotics use density in obstetrics showed a sig-nificant downward trend,the lowest decreased to 9.78 DDD.Conclusion:It is feasible to establish clinical medicine pathways for the prevention of GBS infection in PROM patients,which can effectively reduce the medical cost,the number of days in hospital and the antibiotics use density,and play a positive role in ensuring the safety of maternal and infant patients with PROM.
Premature rupture of membraneGroup B streptococcalAntibacterial drugsMedicine clin-ical pathway
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