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題名 | 內科加護病房院內肺炎感染相關危險因子的探討=Risk Factors for Nosocomial Pneumonia in Medical Intensive Care Unit Patients |
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作者 | 李怡慧; 黃高彬; 蔡季君; 陳彥旭; 黃英絹; 林春珠; 黃樹樺; 吳淑卉; Lee, Yi-whey; Hwang, Kao-pin; Tsai, Jih-jin; Chen, Yen-hsu; Hwang, In-jane; Lin, Chuen-ju; Hwang, Sue-hwa; Wu, Sue-whey; |
期刊 | 院內感染控制雜誌 |
出版日期 | 19981000 |
卷期 | 8:5 1998.10[民87.10] |
頁次 | 頁650-658 |
分類號 | 415.463 |
語文 | chi |
關鍵詞 | 內科加護病房; 院內肺炎感染; 危險因子; 死亡率; ICU; Nosocomial pneumonia; Risk factor; Mortality; |
中文摘要 | 1997年7月至12月,本院一般內科加護病房有184名住院病患,其中97人(52.7%)使用呼吸器,使用呼吸器的病人中出現26名(26.8%)院內肺炎感染,這26名個案是呼吸器相關肺炎(ventilator-associated pneumonia)的高危險群,亦是死亡的重要原因。為預防並有效降低院內肺炎感染率,本研究係針對其相關的危險因子進行探討。結果發現潛在性疾病(呼吸衰竭、敗血症、休克和慢性阻塞性肺疾)、病人年齡(≧60歲)、住院天數(>14天及使用呼吸器>14天)等是院內肺炎感染的相關危險因子(P<0.05)。而潛在性疾病、院內肺炎感染及使用呼吸器的病人與死亡率有顯著相關(P<0.05)。APACHE Ⅱ分數之高低可預測病人之死亡及預後,與死亡率有顯著相關(P<0.05)。院內肺炎感染菌種以Stenotrophomonas maltophilia最多(28.6%),其次是Pseudomonas aeruginosa(21.4%)及Canodida albicans(14.3%)。在上述相關的危險因子,醫護人員可以控制並改善的是侵入性醫療處置--使用呼吸器病人的照護,從插管或氣管切開術到呼吸器保養及管路的更換與消毒均需無菌技術照顧,包括更重要的洗手,皆是杜絕院內肺炎感染最佳的辦法。 |
英文摘要 | Ninty-seven of 184 (52.7%) patients admitted to the medical intensive care unit of our hospital from July, 1997 to December, 1997 required mechanical ventilation. Twenty six (26.8%) episodes of nosocomial pneumonia detected in 97 mechanically ventilated patients were at high risk for developing ventilator-associated pneumonia (VAP), which is a significant cause of mortality. The aim of this study was to investigate the risk factors for nosocomial pneumonia and mortality in order to prevent nosocomial pneumonia. The following variables using univariate techniques were significantly associated with nosocomial pneumonia: the underlying diseases (respiratory failure, P=0.001; sepsis, P=0.002; shock, P=0.007; COPD, P=0.002)、 old age (≧60, p=0.003)、 the duration of ICU stays (> 14 days, P=0.001)、 mechanical ventilation (P=0.001). The following variables were significantly associated with mortality: respiratory failure (P=0.001)、sepsis (P=0.005)、 shock (P=0.001)、 nosocomial pneumonia (P=0.001)、mechanical ventilation(P=0.001)、 and APACHE Ⅱ scores (P=0.047). Stenotrophomonas maltophilia (28.6%) was the most frequent pathogen of nosocomial pneumonia, and the other major ones were Pseudomonas aeruginosa (21.4%) and Candida albicans (14.3%). In conclusion, the health care workers should pay more attention to the care of the invasive medical intervention (e.g.: tracheostomy care, mechanical ventilator maintenance, breathing circuits disinfection and exchanges) to prevent nosocomial pneumonia. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。