發(fā)布時間：2018-02-12 02:53

  本文關鍵詞： ICU 住院患者 耐藥菌 感染 經濟負擔　出處：《山東大學》2017年碩士論文　論文類型：學位論文

【摘要】：目的通過對某三甲醫(yī)院ICU住院患者耐藥菌感染進行目標性監(jiān)測,了解危重患者多重耐藥菌感染的相關因素;了解ICU耐藥菌感染患者的各項住院費用及住院時間,評估患者因耐藥菌感染所造成的直接經濟負擔,為臨床預防用藥、治療和為衛(wèi)生部門制訂切實有效的感染控制政策提供參考。方法采用整群抽樣的方法,研究對象均為2016年1月1日至2016年12月31日入住山東省某三甲醫(yī)院ICU的住院患者,共計454例。包括兩方面的內容:(1)ICU住院患者耐藥菌感染的相關因素:填寫自行設計的《ICU住院患者耐藥菌感染目標性監(jiān)測調查表》,對患者進行目標監(jiān)測。(2)ICU住院患者耐藥菌感染直接經濟負擔研究:將感染組與對照組按照一定條件進行匹配,比較兩組患者之間住院費用和住院天數的差異。數據資料錄入SPSS19.0(Statistical Package for Social Sciences,version 19.0)統(tǒng)計軟件。一般資料采用均數±標準差、率、百分比、構成比等,危險因素分析采用卡方檢驗和Logistic回歸分析等�；颊叩淖≡嘿M用和住院天數用中位數表示,兩組之間的比較采用秩和檢驗。結果1.共納入符合條件的ICU住院患者454例,其中男性272例,女性182例,患者年齡18～94歲,平均年齡59.10±19.97歲。2.納入的454例研究對象,耐藥菌感染131例,感染率為28.90%,感染例次178例,感染例次率39.20%。3.下呼吸道感染是ICU住院患者耐藥菌感染常見的部位,占60.67%,其次是血流感染,占18.54%,第三位的是手術部位感染,占12.36%。4.131例發(fā)生耐藥菌感染的住院患者中,共檢出耐藥菌238株,其中G-細菌180株,占75.63%,G+細菌50株,占21.01%。G-細菌前三位的是鮑曼不動桿菌67株(28.15%),銅綠假單胞菌26株(10.92%),肺炎克雷伯桿菌20株(8.40%),另外,檢出真菌8株(3.36%)。5.ICU住院患者耐藥菌感染與年齡、住院天數、APACHEⅡ評分、基礎疾病、抗菌藥物應用、入ICU前抗菌藥物應用、機械通氣、血液濾過、侵入性操作有關,(P0.05),與性別、入院季度無關(P0.05)。6.Logistic回歸分析顯示ICU住院患者耐藥菌感染的獨立危險因素是住院天數、APACHE Ⅱ評分、機械通氣、基礎疾病、有無手術、入ICU前抗菌藥物使用。7.ICU住院患者耐藥菌感染后額外增加總的醫(yī)療費用為93067元/例,其中西藥費的支出最多,為44832元/例,其次為治療費,為16051元/例。8.耐藥菌感染組平均住院22天/例,較未發(fā)生感染者延長15天/例。9.手術部位耐藥菌感染直接經濟損失最多,為136456元/例,其次為兩個以上部位感染的患者,為111266元/例。不管哪個部位的感染,增加最多的均為西藥費。10.銅綠假單胞菌感染患者直接經濟損失最多,為135014元/例,其次為鮑曼不動桿菌感染患者,為79206元/例。不管哪種耐藥菌的感染,增加最多的均為西藥費。結論ICU住院患者耐藥菌感染發(fā)生率較高。發(fā)生耐藥菌感染獨立的危險因素主要包括住院天數、APACHEⅡ評分、機械通氣、基礎疾病、有無手術、入ICU前抗菌藥物應用等。醫(yī)護人員應根據上述危險因素針對性的采取預防控制措施,減少耐藥菌感染的發(fā)生。耐藥菌感染發(fā)生后會加重患者的經濟負擔,表現為患者住院費用顯著增加,住院時間明顯延長。
[Abstract]:Objective to conduct targeted monitoring of drug-resistant bacteria infection in patients with ICU hospitalized in a hospital, to understand the related factors of multi drug resistant bacteria infection in critically ill patients; understand the hospitalization expenses and hospitalization time of the patients of ICU infection of drug-resistant bacteria, evaluation of patients caused by infection of drug-resistant bacteria of the direct economic burden for clinical prevention and treatment for drug health departments to formulate effective infection control policies to provide a reference. Methods using the cluster sampling method, the subjects were hospitalized ICU patients in a hospital from January 1, 2016 to December 31, 2016 in Shandong Province, a total of 454 cases. The content includes two aspects: (1) the related factors of drug-resistant bacteria infection in patients hospitalized for ICU: complete design the resistant bacteria infection in hospitalized patients, the target monitoring on the patients. (2) study on the direct economic burden of patients with drug-resistant bacteria infection in ICU The infection group were matched according to certain conditions and the control group, the difference between the two groups were compared. The hospitalization days and expense data entry in SPSS19.0 (Statistical Package for Social Sciences, version 19) statistical software. The general data by the mean and standard deviation, rate, percentage, proportion, analyze the risk factors chi square test and Logistic regression analysis. The cost of hospitalization and hospitalization for median, between the two groups were compared using Wilcoxon test. Results 1. of the eligible 454 cases of hospitalized patients with ICU, in which male 272 cases, female 182 cases, 454 cases of patients 18~94 years of age, the mean age of the subjects 59.10 + 19.97 years included in.2., 131 cases of drug resistant bacteria infection, the infection rate was 28.90%. The infection cases in 178 cases, the infection rate of 39.20%.3. lower respiratory tract infection is a common site of drug resistant bacteria infection in hospitalized patients with ICU, Accounted for 60.67%, followed by the bloodstream infection, accounted for 18.54%, third is a surgical site infection, accounting for 12.36%.4.131 cases of hospitalized patients with drug-resistant infections, antibiotic resistant bacteria were detected in 238 strains, including 180 strains of bacteria G-, G+ accounted for 75.63%, 50 strains of bacteria, 21.01%.G- bacteria accounted for three of the Bauman Acinetobacter 67 strains (28.15%), 26 strains of Pseudomonas aeruginosa (10.92%), 20 strains were Klebsiella pneumoniae (8.40%), in addition, 8 strains of Candida (3.36%) patients with.5.ICU resistant bacteria infection and age, hospitalization time, APACHE score, basic diseases, antibacterial drugs application, ICU antibacterial application of Medicine, mechanical ventilation, blood filtration, invasive operation, (P0.05), and gender, admission quarter independent (P0.05).6.Logistic regression analysis showed that ICU were independent risk factors of drug resistant bacteria infection in patients with the hospitalization time, APACHE score, mechanical ventilation, basic disease, with or without surgery, before admission to ICU The use of antibacterial drugs in patients with.7.ICU resistant bacterial infection after hospitalization additional total medical cost of 93067 yuan / cases, including western medicine expenses up to 44832 yuan / case, the second is treatment fee, 16051 yuan / cases of.8. resistant bacteria infection group, the average hospitalization days were 22 cases with / without infection, prolonged 15 day /.9. cases of surgical site infection of drug-resistant bacteria in direct economic losses up to 136456 yuan / case, followed by more than two sites of infection, 111266 yuan / cases. No matter which part of the infection, the largest increase was the cost of Western medicine.10. Pseudomonas aeruginosa infection in patients with the most direct economic loss of 135014 yuan. / cases, followed by Bauman Acinetobacter infection patients, 79206 yuan / cases. No matter what kind of drug resistant bacteria infection, the largest increase are medicine fee. Higher incidence of drug-resistant bacteria infection in hospitalized patients. Conclusion ICU dangerous drug resistant bacteria infection independent factors. The duration of hospitalization, APACHE score, mechanical ventilation, basic disease, with or without surgery, ICU before the application of antimicrobial agents. The medical staff should be based on these risk factors take targeted prevention and control measures, reduce the occurrence of drug resistant bacteria infection. After will increase the economic burden of patients infected with drug-resistant bacteria showed a significant increase the cost of hospitalization, hospitalization time was significantly prolonged.

【學位授予單位】：山東大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R473

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