比較敗血症組合式照護的遵從度與其實施成效探討-回溯性世代研究

Comparison of Sepsis Bundle Adherence and Outcome of Sepsis Patients-Retrospective cohort study

吳佩芬(Pei-Fen Wu)

指導教授 ： 黃正宜

共同指導教授 ： 葉志嶸(Chih-Jung Yeh)

中山醫學大學/醫學院/護理學系/碩士(2020年)

https://doi.org/10.6834/csmu202000210

摘要

背景: 敗血症是威脅生命的醫療緊急狀況，其罹病率會隨年齡增長而增加，更是住院死亡率的主要原因。敗血症組合式照護介入可降低其死亡率和減輕患者負擔，護理師是患者就醫時，組合式照護的第一線執行者，任職醫院雖有實施敗血症組合式照護，但無設置敗血症組合式照護之標準流程及敗血症相關的研究資料，故藉由此次研究來瞭解醫院敗血症患者的照護成效，及瞭解未能遵從組合式照護的現況，作為未來改善實施敗血症組合式照護方案設計的依據。
方法: 本計畫為回溯性世代研究，收集2017年01月至2018年12月台灣某區域教學醫院入住內科加護病房敗血症患者的資料，使用卡方檢定、單因子變異數分析、Kaplan-Meier method與Cox proportional Hazards Regression Model，進行敗血症組合式照護遵從情形與實施成效的資料分析。
結果: 完全遵從敗血症組合式照護28天死亡率與未完全遵從分別為10.0%與34.2%(p=0.114)，能顯著減少患者之負擔如呼吸器使用和醫療花費。若患者主訴為呼吸道症狀，則敗血症照護遵從度較低(p=0.015)。
結論: 敗血症組合式照護遵從低無法降低死亡率，可藉由敗血症標準流程設置，提升遵從度，以降低患者與醫護人員之負擔。

關鍵字

敗血症 ； 敗血性休克 ； 敗血症組合式照護 ； 遵從度

並列摘要

Background: Sepsis is a life-threatening medical emergency, which is increased by age and cause poor prognosis in hospital. Sepsis bundle care can reduce mortality rate and medical burden of patients. Nurses are the primary care providers contacted by patients when they seek medical treatment. Though hospitals have critical care systems, there is no standard protocol and no relevant research data for sepsis bundle care. Therefore, this study investigated the effectiveness of the bundle care for sepsis patients in a hospital, and analyzed the reasons for failure to comply with the sepsis bundle care, as a basis for improving the design of standard protocol for sepsis in the future.
Method: This is a retrospective cohort study. From January 2017 to December 2018, patients with sepsis admitted to the intensive care unit of a regional teaching hospital in Taiwan were enrolled. Using chi-square test, one way ANOVA, Kaplan-Meier method and Cox proportional hazard regression model for the relationship between the adherence of sepsis bundle care and its implementation effectiveness was surveyed.
Results: The 28-day mortality rate and non-adherence percentage of the sepsis bundle care were 10.0% and 34.2%, respectively (p = 0.114). However, medical utility as mechanical ventilator and medical expenses were decreased significantly. The adherence rate was lower (p = 0.015) in sepsis patients with respiratory symptoms as chief complaint.
Conclusion: Low adherence with sepsis bundle care could not reduce mortality. The standard protocol for sepsis bundle care should be implanted to increase adherence and to reduce the clinical burden of patients and medical staffs.

並列關鍵字

Sepsis ； Septic Shock ； Sepsis Bundle Care ； Adherence

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