- 期刊
外科加護病房呼吸器管路更換頻率與其肺炎相關感染率之比較
Different Frequencies in Ventilator Circuit Changes in Surgical Intensive Care Units and its Relationship to the Occurrence of Ventilator-Associated Pneumonia
摘要
根據國外文獻報導：呼吸器管路延長更換時間，不會影響病人之肺炎感染率，但是否可推論至國內各類型之醫院值得深思。因此希望藉由本土的研究在不影響醫療品質之前題下，評估呼吸器管路每周更換二次與每周更換一次其呼吸器相關肺炎感染率(ventilator-associated pneumonia; VAP)之差異，於是分別收集了外科加護病房民國88年12月1日至89年4月30日之病人作為對照組（卽每週更換二次）及民國89年12月1日至90年4月30日之病人作為研究組（卽每週更換一次）之人口學資料及使用呼吸器之相關危險因子後，比較兩組在各變項之分佈情形。對照組有561人次之個案，男性有322人次，女性有239人次，平均年齡為58.9±8.2歲，總共使用呼吸器人日數為3,562，呼吸器相關肺炎感染人次為21，感染率為5.9/1000使用呼吸器人日數，平均使用呼吸器之天數為6.3±11.9，平均停留在加護病房之天數為9.1±13.0，研究組有623人次之個案，男性有402人次，女性有221人次，平均年齡為61.5±5.9歲，總共使用呼吸器人日數為3,290，呼吸器相關肺炎感染人次為11,感染率為3.3/1000使用呼吸器人日數，平均使用呼吸器之天數為5.3±9.9，平均停留在加護病房之天數為8.0±10.4。兩組經Poisson regression model調整各變項後，兩組之RR為0.945,P值為0.886，其中病患入加護病房時肺部狀況(RR=0.152, P=0.0001)、使用呼吸器天數(RR=8.885, P=0.005)與肺炎之發生，具有統計上之差異。兩組在使用呼吸器天數長短與呼吸器相關肺炎之累積發生率，經存活分析，P值為0.239。結論是呼吸器管路一周更換二次與一周更換一次其呼吸器相關肺炎感染率無統計上之差異。
並列摘要
Some studies demonstrated that reducing the frequency of the ventilator circuit changes will not increase the chance of nosocomial pneumonia. In Taiwan, there has been no similar study to show such a result. We evaluated the effect of decreasing the frequency of circuit changes from twice weekly to once weekly. A retrospective study was done at the surgical intensive care units of National Taiwan University Hospital. During the period from December 1, 1999 till April 30, 2000, the circuit was changed twice a week, and that served as the control group. During December 1, 2000 till April 30, 2001, the circuit was changed only once a week, and this served as the study group. All patients who stayed at the SICU and used ventilators were included. There were no significant differences in the demographic data and the risk factors between the 2 groups. There were 561 cases (male: female=322:239) in the control group) with a mean age of 58.9±8.2 years. Total ventilation days were 3,562 and the infection rate of ventilator-associated pneumonia was 6.3±11.9, and the mean ICU stay was 9.1±13 days. In the study group, there were 623 cases (male: female=402:221) with a mean age of 61.5±5.9 years. The total ventilation days were 3,290 and the infection rate of ventilator-associated pneumonia was 3.3/1,000 ventilator days. The mean ventilatorusing day was 5.3±9.9 and the mean ICU stay was 8.0±10.4 days. By Poisson regression model, the RR=0.945, P=0.886, only two factors were statistical significantly related to the ventilator-associated pneumonia: the patient’s lung condition when he/she entered SICU (RR=0.152, P=0.0001); and the ventilator-using days (RR=8.885, P=0.005). Survival analysis about the probability of acquiring ventilator-associated pneumonia by ventilator-using days demonstrated that there is no significant difference in the occurrence of ventilator-associated nosocomial pneumonia between the control group and the study group.