中国临床药学杂志

目的 探讨应用属性层次模型评价Ⅱ类切口手术围术期预防性使用抗菌药物合理性的效果，并建立Ⅱ类切口手术围术期预防性使用抗菌药物临床评价体系。方法 依据Ⅱ类切口手术围术期抗菌药物预防性使用规范构建临床评价标准，运用属性层次模型对2022年10月至2024年3月的900例行Ⅱ类切口手术患者的病历进行合理性评价。结果 将Ⅱ类切口手术围术期预防性使用抗菌药物的不合理问题类型按扣除分值由高至低排列，排名靠前的有用药疗程（438.45分）、给药时机（303.81分）、药物选择（51.87分）及术中追加（13.34分）。病历评分为100（优秀）的病历占比最高（占92.56%）,90≤病历评分<100（良好）的病历占3.22%，病历评分<90（不合格）的病历占4.22%。结论 基于属性层次模型建立的Ⅱ类切口手术围术期预防性使用抗菌药物临床评价体系，能够更客观地反映病历合理性程度，可在临床用药合理性评价中推广应用。该院Ⅱ类切口手术围术期预防性使用抗菌药物存在不合理现象，需进一步提高用药的合理性。

AIM To explore the application of the attribute hierarchy model(AHM) in evaluating the rationality of perioperative prophylactic antibiotic use for Class Ⅱ incision surgery, and to establish a clinical evaluation system for perioperative prophylactic antibiotic use in Class Ⅱ incision surgery. METHODS Clinical evaluation criteria were constructed according to the standard of perioperative prophylactic use of antibiotics for Class Ⅱ incision surgery. The AHM was used to evaluate the rationality of the medical records of 900 cases of patients with Class Ⅱ incision surgery from October 2022 to March 2024. RESULTS The types of irrational prophylactic use of antibiotics in type Ⅱ incision surgery were ranked by descending deduction points, with the leading types being duration of medication(438.45 points), timing of administration(303.81 points), drug selection(51.87 points), and intraoperative supplementation(13.34 points). Medical record scores of 100(excellent) accounted for the highest proportion(92.56%), scores between 90 and below 100(good) accounted for 3.22%, and scores below 90(unqualified) accounted for 4.22%. CONCLUSION The clinical evaluation system for the perioperative prophylactic use of antibiotics based on AHM can more objectively reflect the rationality of medical records and be widely applied to evaluate the rationality of clinical drug use. There are still unreasonable phenomena in the perioperative prophylactic use of antibiotics for Class Ⅱ incision surgery, and the rationality of drug use should be further improved.