论文部分内容阅读
目的 :了解上海地区下呼吸道医院感染的确切发生率、常见危险因素与经济损失等监测数据。方法 :采用回顾性队列研究方法。从 5 5所核定床位在 40 0张以上的医院中 ,抽出 18所综合性医院 ,组织近 40名防治医院感染专业人员对 1999年 10月份出院病例进行专项调查。结果 :调查的 192 35例出院病人 ,共发现下呼吸道医院感染病例 40 2例 ,415例次。平均发生率为 2 .1%。按科室计神经内科发生率最高 (5 .4%) ,其次为血液科 (4 .8%) ;妇产科、儿科和眼耳鼻喉科则不足 1%。平均每 10 0 0住院日发生下呼吸道医院感染 1.0例。Logistic多因素回归分析显示 ,人工气道 /呼吸机连续使用≥ 3d ,发生下呼吸道医院感染的相对危险度 (RR)为 16 .7;6 5～ 79岁老年人的RR为 4.2 ,而 80岁以上的高龄者则达 6 .0 ;颅脑外科手术并发下呼吸道感染是对照组的 2 .3倍。下呼吸道医院感染造成的损失显著 ,感染组住院时间 5 1d ,较对照组延长 31.0d ,每例增加医疗费用平均 18386 .1元。下呼吸道医院感染病死率 2 5 .8%,而无感染组仅 2 .3%。结论 :上海地区下呼吸道医院感染发病率甚高 ,危害严重 ,应采取有效措施 ,切实降低其发病率。
OBJECTIVE: To understand the exact incidence of nosocomial infections of lower respiratory tract in Shanghai, common risk factors and economic losses. Methods: A retrospective cohort study was used. Of the 55 approved hospitals with more than 40 beds, 18 general hospitals were selected and nearly 40 professionals in prevention and treatment of nosocomial infections were organized to conduct a special investigation on discharged patients in October 1999. Results: Of the 192 35 discharged patients surveyed, 40 2 were hospitalized with lower respiratory tract infections and 415 were hospitalized. The average incidence was 2.1%. According to the departments of neurology, the highest incidence (5.4%), followed by hematology (4.8%); obstetrics and gynecology, pediatrics and ENT less than 1%. On average, 100 hospitalized cases of lower respiratory tract infection occurred every 100 days of hospitalization. Logistic multivariate regression analysis showed that the relative risk (RR) of hospital-acquired airway / nosocomial infections was ≥7 days after continuous use of artificial airway / ventilator was 16.7; RR of elderly at 65-79 years old was 4.2 while that of 80-year-old Over 6.0 elderly people; craniocerebral surgery complicated with lower respiratory tract infection was 2.3 times the control group. Lower respiratory tract hospital infection caused significant losses, infection group hospitalized 51d, compared with the control group extended 31.0d, an increase of 18386 .1 yuan for each case of medical expenses. The lower respiratory tract infection rate was 25.8% in hospital without infection and only 2.3% in non-infected group. Conclusion: The incidence of nosocomial infection of lower respiratory tract in Shanghai is very high and serious. Effective measures should be taken to reduce its incidence.