老年心脏瓣膜病患者瓣膜置换术后医院感染危险因素及经济负担  

Risk factors for postoperative nosocomial infection in elderly valvular heart disease patients undergoing heart valve replacement surgery and economic burden

作　　者：王续晶 姚雪[1,2] 张玉君 卢冉冉 王书会 WANG Xu-jing;YAO Xue;ZHANG Yu-jun;LU Ran-ran;WANG Shu-hui(School of Nursing and Rehabilitation,Shandong University,Jinan,Shandong 250012,China;不详)

机构地区：[1]山东大学护理与康复学院,山东济南250012 [2]山东大学齐鲁医院感染管理处,山东济南250012

出　　处：《中华医院感染学杂志》2022年第21期3282-3286,共5页Chinese Journal of Nosocomiology

摘　　要：目的分析老年心脏瓣膜病(VHD)患者心脏瓣膜置换术后医院感染危险因素及经济负担。方法选取2018年1月1日-2019年12月31日山东大学齐鲁医院行心脏瓣膜置换术治疗的老年VHD患者333例,根据术后是否发生医院感染分为感染组91例与未感染组242例。采用单因素及多因素Logistic回归分析术后医院感染的危险因素。采用流行病学病例对照方法对感染组和未感染组患者进行1∶1病例匹配,分析感染造成的直接经济负担。结果单因素及多因素Logistic回归分析结果显示术前心力衰竭、美国麻醉医师协会分级(ASA),术后高碳酸血症、胸腔积液、应激性高血糖,实际住院天数、留置尿管时间与术后医院感染相关(P<0.05)。医院感染发生后患者实际住院时间延长6 d,直接经济负担可达52770.92元,西药费在单项费用支出差值中最大(17505.74元)。结论术前心力衰竭、ASA分级,术后高碳酸血症、胸腔积液、应激性高血糖,实际住院天数,留置尿管时间是老年VHD患者瓣膜置换术后发生医院感染的危险因素,预防术后医院感染的发生有利于减轻患者及医院的经济负担。OBJECTIVE To analyze the risk factors for postoperative nosocomial infection in elderly valvular heart disease(VHD)patients undergoing heart valve replacement surgery and investigate the economic burden.METHODS A total of 333 elderly VHD patients who underwent heart valve replacement surgery in Qilu Hospital of Shandong University from Jan 1,2018 to Dec 31,2019 were enrolled in the study and divided into the infection group with 91 cases and the no infection group with 242 cases according to the status of postoperative nosocomial infection.The case matching in a 1∶1 ratio was carried out for the patients of the infection group and the no infection group by epidemiological case-control method,and the direct economic burden induced by the infection was observed.RESULTS The results of univariate analysis and multivariate logistic regression analysis showed that preoperative heart failure,physical status classification of American Society of Anesthesiologists(ASA),postoperative hypercapnia,pleural effusion,stress hyperglycemia,actual length of hospital stay and urinary catheter indwelling time were associated with the postoperative nosocomial infection(P<0.05).The acute length of hospital stay of the patients with nosocomial infection was prolonged by 6 days,the direct economic burden was 52770.92 yuan,and the cost of western medicine was the largest in the single cost expenditure difference(17505.74 yuan).CONCLUSION The preoperative heart failure,physical status classification of ASA,postoperative hypercapnia,pleural effusion,stress hyperglycemia,actual length of hospital stay and urinary catheter indwelling are the risk factors for the postoperative nosocomial infection in the elderly VHD patients undergoing heart valve replacement surgery.The prevention of postoperative nosocomial infection can reduce the economic burden of the patients and the hospital.

关 键 词：老年 心脏瓣膜置换术 医院感染 危险因素 经济负担 

分 类 号：R542.5[医药卫生—心血管疾病]