摘要
目的:探讨行内镜逆行胰胆管造影(endoscopic retrograde cholangiopancreatography,ERCP)患者术后发生感染的相关影响因素,分析发生感染后造成的经济负担,为确定感控策略的投入和实施提供依据。方法:采用回顾性调查方法,对2014~2018年在我院行ERCP手术患者593例的感染发生情况进行调查,分析发生感染的影响因素;同时将术后发生医院感染的49例患者为感染组,采用1∶1倾向性评分匹配(propensity score matching,PSM)选取同期病例为病例对照组,比较感染组和病例对照组的住院费用和住院时间。结果:593例住院患者中,发生医院感染49例,发生率为8.26%。其中发生胆道感染34例,占69.39%。采集术后感染患者感染部位的标本送微生物培养,共检出病原体26例,其中革兰阳性菌4例,占15.38%;革兰阴性菌22例,占84.62%。且胆汁中检出病原体最多,占50.00%。单因素分析显示,年龄、民族、合并糖尿病对ERCP术后感染影响显著(P<0.05)。感染组住院时间中位数为19 d,病例对照组为10 d,差异有统计学意义(Z=-3.986,P<0.001)。感染组和病例对照组住院总费用中位数分别为37064.26元和27428.19元,差异有统计学意义(Z=-3.307,P<0.001)。结论:年龄、合并糖尿病、民族是ERCP术后发生感染的影响因素,而发生感染会显著增加患者的住院时间和经济负担。应当采取相应的干预措施,降低其感染发生率,提高医疗质量,保障医疗安全。
Objective:To explore the related factors of postoperative infection in patients with endoscopic retrograde cholangiopancreatography(ERCP),and to analyze the economic burden of patients after infection,so as to provide confirmation basis for determining the input and implementation of sensory control strategy.Methods:A total of 593 inpatients undergoing ERCP in our hospital from 2014 to 2018 was investigated by retrospective investigation,and the influencing factors of infection were analyzed.At the same time,49 patients with hospital infection after operation were selected as infection group.The patients in the same period matched with propensity score matching(PSM)by 1∶1 were selected as case control group.The hospitalization expenses and hospitalization days between the infection group and case control group were compared.Results:Among the 593 inpatients undergoing ERCP,49 cases had hospital infection,the incidence of hospital infection was 8.26%,of which 34 cases(69.39%)had bile duct infection.The specimens of the infected patients were collected and cultured for 26 times,including 4 cases of Gram-positive bacteria(15.38%)and 22 cases of Gram-negative bacteria(84.62%).Pathogens were detected in 13 cases(50.00%)in bile.Univariate analysis showed that age,nationality and diabetes mellitus could significantly affect the occurrence of postoperative infection(P<0.05).The median hospitalization days of infection group was 19 days,and that of case control group was 10 days,the differences between the two groups were statistically significant(Z=-3.986,P<0.001).The median total hospitalization cost of the infection group and the case control group was 37064.26 yuan and 27428.19 yuan,the differences were statistically significant(Z=-3.307,P<0.001).Conclusion:Age,diabetes,the nationality is the influencing factors of the infection after the ERCP operation,and the patient′s hospitalization days and the direct economic burden are significantly increased.The corresponding intervention measures should be taken to reduce
作者
绽丽
杨冬华
马晓丽
张永栋
ZHAN Li;YANG Donghua;MA Xiaoli;ZHANG Yongdong(Department of Nosocomial Infection Management,Affiliated Hospital of Qinghai University, Xining 810001,China)
出处
《西北国防医学杂志》
CAS
2020年第5期297-302,共6页
Medical Journal of National Defending Forces in Northwest China
基金
青海省卫生和计划生育委员会资助项目(2016-wjzdx-63)。
