成年病人醫院感染性肺炎危險因子分析─以神經外科為例

Predictors of Hospital-acquired Pneumonia in Adult Patients

黃牧琦(Mu-Chi Huang)

指導教授 ： 蔡佩珊

臺北醫學大學/護理學院/護理學研究所/碩士(2014年)

https://doi.org/10.6831/TMU.2014.00110

摘要

研究目的：探討成年住院病人發生醫院感染性肺炎之危險因子。
研究方法：本研究為以醫院為基礎的配對病例對照研究。利用某區域教學醫院2007年至2011年之出院病人資料庫，篩選出20歲以上且診斷為肺炎或吸入性肺炎（ICD-9-code 480-486與507.0-507.9）之神經外科病人為病例組；以住院日為配對條件，選取20歲以上、住院天數大於三天並於住院期間未發生醫院感染性肺炎之神經外科病患為對照組。統計方式採描述性統計與多變量邏輯式迴歸。
研究結果：本研究各收取72位與59位神經外科病患至案例與控制組。大多數病患為男性且超過一半病患的年齡為65歲或以上。多變量邏輯式迴歸顯示吞嚥困難與頭部外傷為成年神經外科病患發生醫院感染性肺炎之危險因子（p < .001與p = .048）。
結論：（一）臨床照護實務面：照護團隊應針對具有中樞神經疾病之病人，特別是頭部外傷病人，監測吞嚥困難之症狀並介入有效性介入措施以降低醫院感染性肺炎之風險。（二）護理教育面：建議在醫院感染性肺炎感照護與預防教育中，可將吞嚥困難之監測、照護與預防措施最新趨勢列入教育內容。

關鍵字

醫院感染性肺炎 ； 肺炎 ； 危險因子

並列摘要

Purpose：To examine risk factors of hospital-acquired pneumonia in hospitalized adult patients.
Methods: This was a hospital-based, matched case-control study. The data were retrieved from the 2007 to 2011 Hospital Discharge Patients Database in a public teaching hospital. We identified neurosurgical patients who aged 20 years or above, were admitted to the hospital for more than 3 days, and received a diagnosis of pneumonia or aspiration pneumonia (ICD-9-code 480-486 or 507.0-507.9) as the case group. Neurosurgical patients who aged 20 years or above, were hospitalized more than 3 days, and without the occurrence of hospital-acquired pneumonia during hospitalization, matched by admission day, were selected as the control group.
Results: Overall, 72 and 59 participants were included in the case and control groups, respectively. The majority of participants were male and half of them were 65 years of age or older. Dysphagia and head injury were significant risk factors for hospital-acquired pneumonia in neurosurgical patients (p < .001, and p = .048).
Conclusions: (1) Clinical implications: Health care providers should focus on monitoring the symptom of dysphagia and design effective interventions to reduce the risk of hospital-acquired pneumonia in neurosurgical patients, particularly in patients with head injury. (2) Implications for nursing education: We suggest that the care and prevention strategies of dysphagia should be integrated into the nursing care education regarding hospital-acquired pneumonia.

並列關鍵字

Predictors ； Hospital-acquired Pneumonia ； Pneumonia

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