創傷病人罹患呼吸器相關肺炎之危險因子與醫療利用

The Risk Factors and Utilization of Trauma Patient with Ventilator-Associated Pneumonia (VAP)

蘇健智(Jian-Jhih Su)

指導教授 ： 楊銘欽

國立臺灣大學/公共衛生學院/健康政策與管理研究所/碩士(2011年)

https://doi.org/10.6342/NTU.2011.00986

摘要

研究背景與目的：
呼吸器相關肺炎為醫院感染控制的重要議題之一，也是影響病人預後的一個重要併發症。本研究之目的主要是分析創傷病人罹患呼吸器相關肺炎的危險因子，並且探討呼吸器相關肺炎對創傷病人在醫療利用上可能造成的影響。
研究方法：
本研究採用國家衛生研究院所提供之全民健康保險學術研究資料庫2005年百萬承保抽樣歸人檔中2005-2007年的資料，研究樣本最後選取使用呼吸器達兩天以上之創傷病人共1,010人，其中罹患呼吸器相關肺炎者共166人。以威爾克森符號等級檢定(Wilcoxon signed-rank test)及卡方檢定作檢定，並採用逐步複迴歸及逐步羅吉斯迴歸統計方法探討創傷病人罹患呼吸器相關肺炎的危險因子及其對病人醫療利用和死亡的影響。
研究結果：創傷病人於加護病房住院期間發生呼吸器相關肺炎之發生率為16.44%；未罹患呼吸器相關肺炎的創傷病人平均加護病房住院天數為10天、總住院天數為23天、醫療費用為255,427元，罹患呼吸器相關肺炎的創傷病人平均加護病房住院天數為15天、總住院天數為32天、醫療費用為317,537元；多變項分析結果顯示年齡較大、患有敗血症、或呼吸器使用天數較長為創傷病人罹患呼吸器相關肺炎的危險因子；罹患呼吸器相關肺炎者加護病房住院天數顯著較長及總住院天數超過中位數(20天)的機會顯著較高；是否罹患呼吸器相關肺炎與醫療費用無顯著相關，但罹患的創傷病人藥費/藥事服務費用、診察/檢查/治療處置費用及病房費用占總費用的比例以及支出金額都較高；創傷病人是否罹患呼吸器相關肺炎與死亡風險無顯著相關。
研究結論：
年齡較大、罹患敗血症、或呼吸器使用天數較長為罹患呼吸器相關肺炎的危險因子；罹患呼吸器相關肺炎傾向增加創傷病人的加護病房住院天數及總住院天數，但對於醫療費用及死亡風險則無顯著影響。

關鍵字

呼吸器相關肺炎 ； 創傷 ； 全民健康保險

並列摘要

Background and objectives:
Ventilator-associated pneumonia (VAP) not only is one of the important issues of infection control, but also an important complication affecting patients’ prognosis. The main purpose of this research is to analyze the risk factors of trauma patient with VAP and the association with medical care utilization.
Methods:
Data came from claims data file of 100 million sampled registry from Taiwan National Health Insurance Research Database from 2005 to 2007. A total of 1,010 trauma patients who received invasive mechanical ventilator for >48 hours were analyzed in this study. Differences were compared by using Wilcoxon signed-rank test and Chi-square test; Risk factors for VAP and assciation with medical care utilization were examined by using logistic regression and multiple linear regression.
Results:
Of the total of 1,010 patients, 166 (16.44%) developed VAP during hospitalization. Logistic regression analysis showed that age > 65, having sepsis and having longer duration of mechanical ventilation were factors associated with developing VAP. Trauma patients with VAP had significantly longer ICU stay (15 versus 10, P<0.001), and hospital stay (32 versus 23, P<0.001), and higher health care expenditure (NT$317,537 versus NT$255,427, P<0.001). Multiple linear regression analysis indicated that VAP significantly prolonged trauma patients’ ICU stay and hospital stay, but didn’t significantly increase patients’ expenditure and mortality rate after controlling for other factors.
Conclusions:
Age>65, suffering sepsis or long duration of mechanical ventilation were risk factors for developing VAP for trauma patients. VAP was associated with patients’ ICU stay and hospital stay.

並列關鍵字

ventilator-associated pneumonia ； trauma ； National Health Insurance

參考文獻

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