多准则决策分析在重症肺炎集束化治疗中的意义  

The significance of multi-criteria decision analysis for the bundle treatment of severe pneumonia

作　　者：徐俊马[1] 赵杰[1] 贾晓民[1] 王海清[1] 王刚[2] 李海泉[1] 

机构地区：[1]徐州医学院第二附属医院呼吸科,江苏徐州221006 [2]徐州医学院肿瘤研究所,江苏徐州221000

出　　处：《中华危重病急救医学》2015年第10期796-799,共4页Chinese Critical Care Medicine

基　　金：国家自然科学基金（81400055）

摘　　要：目的：探讨多准则决策分析（MCDA）在重症肺炎集束化治疗中的作用。方法采用与历史对照的前瞻性观察性研究方法，以2013年1月至2014年8月徐州医学院第二附属医院呼吸内科收治的75例重症肺炎患者作为前瞻性干预组，由医护人员组成MCDA小组，根据MCDA评估结果选取集束化治疗措施与抗感染、化痰等常规治疗措施组成捆绑式治疗方案，并随时进行调整，直至患者转出呼吸重症加强治疗病房（RICU）或死亡。以2010年8月至2012年12月呼吸内科收治的70例重症肺炎患者作为历史对照组。比较两组患者治疗前基线资料及治疗期间院内感染（院感）发生率、人均住院费用、RICU住院时间及病死率。结果两组患者治疗前性别、年龄、基础疾病、入院时急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分等比较差异均无统计学意义，有可比性。与对照组相比，干预组治疗期间院感发生率明显下降〔1.33%（1/75）比11.43%（8/70），χ2＝4.723，P＝0.030〕，RICU住院期间人均住院费用明显下降（万元：3.44±0.79比3.76±0.91，t＝2.265，P＝0.025），RICU住院时间明显缩短（d：15.01±4.22比16.92±4.79，t＝2.552，P＝0.012）、RICU病死率明显下降〔8.0%（6/75）比21.4%（15/70），χ2＝5.272，P＝0.032）。结论 MCDA应用于构建重症肺炎的集束化管理，提高了决策的科学性，降低了个体医疗费用，达到了落实指南、改善患者临床结局和预后的目的。ObjectiveTo determine the effect of multi-criteria decision analysis （MCDA） on the effect of bundle treatment for severe pneumonia.Methods A prospective historical control observation was conducted. Seventy-five patients with severe pneumonia having received MCDA （from January 2013 to August 2014） were assigned as intervention group. MCDA group was set up by the medical staff. Bundled treatment plan was composed of the MCDA evaluation results, anti-infection, phlegm and other conventional treatment measures which was adjust on time until the patient was transferred out of the respiratory intensive care unit （RICU） or died. Seventy patients with severe pneumonia before receiving MCDA （from August 2010 to December 2012） were set as historical control group. Comparison of general condition before treatment and the incidence of hospital infection, average hospitalization cost, duration of RICU stay and mortality between these two groups were performed.Results There were no statistically significant differences in gender, age, past history, and acute physiology and chronic health evaluationⅡ （APACHEⅡ） score at admission between two groups. Compared with control group, the incidence of hospital infection [1.33% （1/75） vs. 11.43% （8/70）,χ2 = 4.723,P = 0.030], mean hospitalization cost in RICU （10 thousand Yuan： 3.44±0.79 vs. 3.76±0.91,t = 2.265, P = 0.025）, length of RICU stay （days： 15.01±4.22 vs. 16.92±4.79,t = 2.552,P = 0.012） and mortality in RICU [8.0% （6/75） vs. 21.4% （15/70）,χ2 = 5.272,P = 0.032] in intervention group was significantly decreased. Conclusions Application of MCDA in the bundle treatment of severe pneumonia could elevate the scientificalness of decision, and reduce the medical cost. Additionally, MCDA is worth to be generalized because the implementation of guidelines can improve the clinical outcome and prognosis of the patients.

关 键 词：多准则决策分析 重症肺炎 集束化治疗措施 

分 类 号：R563.1[医药卫生—呼吸系统]