- 學位論文
不同治療模式下蜂窩性組織炎的治療成效與醫療耗用之比較
Comparison of the Effectiveness of Treatment and Medical Consumption of Different Treatment Modalities of Cellulitis
摘要
研究目的 一、探討不同治療模式下蜂窩性組織炎的治療成效。 二、探討不同治療模式下蜂窩性組織炎的醫療耗用。 三、探究蜂窩性組織炎治療成效的相關因素。 四、探究蜂窩性組織炎醫療資源耗用的相關因素。 研究方法 以南部某醫學中心病歷資料庫，採病歷回顧進行資料分析，以民國101年1月到民國102年12月的急診及住院病歷，選取主診斷為蜂窩性組織炎者為研究樣本，總樣本數為361人。本研究觀察蜂窩性組織炎患者的病歷記錄及治療模式。將病歷資料分成兩組，一組在急診接受治療後，安排出院；一組安排住院接受治療。紀錄兩組病人的生命徵象、實驗室報告 (如白血球計數，急性發炎指數，血液細菌培養等)，並分析比較其留院天數、抗生素使用情形及出院後24小時或48小時是否重返急診等。使用SPSS for Windows 19.0統計套裝軟體進行描述性與推論性統計分析。 研究結果 在急診接受治療組有68人，平均急診治療天數為1.06天，；住院接受治療組有260人，平均留院治療天數為8.53天；兩組病患之年齡、性別、身體質量指數、體溫、心跳、呼吸值、白血球計數、急性發炎指數、肌酸激酶值、血清肌酸酐、血糖值、是否有中風、血液透析、糖尿病無顯著差異；在治療成效方面，在急診接受治療組出院後24小時再重返急診顯著較多；而出院後48小時是否再重返急診兩組無顯著差異。出院後24小時是否再重返急診與留院天數相關；出院後48小時是否再重返急診與籍貫、保險別、第二次急性發炎指數、疾病數目相關。留院天數與第一次急性發炎指數、第一次血糖值相關。 結論與建議 本研究指出，某些特性的蜂窩性組織炎患者在急診進行治療，其療效等同住院進行治療，而在急診進行治療的治療天數較短，醫療資源耗用較少。建議運用急診治療模式對合適的病人進行治療，減少醫療耗用。
並列摘要
Objective 1. To investigate the effectiveness of treatment in different treatment modalities on cellulitis. 2. To understand medical consumption in cellulitis treated by different treatment modalities. 3. To explore related factors of treatment effectiveness about cellulitis. 4. To explore related factors of medical resources consumption about cellulitis. Methods We used emergency and inpatient medical records from a medical center in southern medical database, by chart review to analyze the data collected between January 2012 and December 2013. We selected the primary diagnosis of cellulitis as research samples, and the total samples were 361 people. This study focused upon the patients' medical records and treatment modalities. The medical records were divided into two groups, one group, emergency group, was discharged after emergency treatment; the other, hospitalized group, were arranged to admission treatment. We recorded the patients' vital signs, laboratory reports (such as white blood cell count, liver function, renal function and blood culture, etc.). We analyzed and compared the patients' length of stay in hospital and patients' revisit to the emergency department in 24 hours or 48 hours. We used SPSS for Windows 19.0 statistical software package descriptive and inferential statistical analysis. Results There were 68 people treated in the emergency group, and the average length of stay in the hospital was 1.06 days; whereas the 260 people of the hospitalized group, the average length of stay in the hospital were 8.53 days; there were no significant differences in the patients' age, gender, body mass index, body temperature, heart rate, respiration rate, leukocyte count, acute inflammation index, creatine kinase, serum creatinine, blood glucose, and whether there was a stroke, hemodialysis, or diabetes. When it came to the treatment effectiveness, the emergency group had a higher numbers of 24-hours emergency revisits. And there was no significant difference between the two groups about the 48- hours emergency revisits. The presence of 24- hours emergency revisits is related to the length of hospital stay. The numbers of 48- hours emergency revisits were related to the place of birth, insurance classficiation, the second check-up value of acute inflammation index, the number of diseases. The length of stay in the hospital is related to the first check-up value of acute inflammation of the index, the first check-up blood glucose. Conclusions and Recommendations This study points out patients in the emergency ward, with the diagnosis of cellulitis of certain specific characteristics may have equivalent treatment effectiveness in comparison with the hospitalized group. We found the length of stay in the hospital is shorter in the emergency treatment group; and thus less medical resources consumption. We recommend the use of emergency treatment modalities for appropriate, selective patients with cellulitis to reduce medical consumption.