院内感染对先天性心脏病直接医疗经济负担的影响

Impact on direct medical economic burden from nosocomial infection in patients with congenital heart disease

目的探讨院内感染对常见先天性心脏病直接医疗经济负担的影响,为临床医疗实践提供循证医学证据。方法采用回顾性调查方法,对2006年至2008年在某三甲医院接受外科手术治疗的2 429例先天性心脏病患者进行调查,通过查询病历记录(医院信息系统)获得直接医疗经济负担(direct medical economic burden,DMEB)指标,采用SAS 9.2软件进行统计学处理分析,统计推断采用t′检验,对混杂因素的控制采用协方差分析及分层分析方法。结果两种常见先天性心脏病房间隔缺损、室间隔缺损患者总的院内感染率为7.00%(170/2 429),以呼吸道感染为主。院内感染明显地增加了先天性心脏病DMEB,发生院内感染组的DMEB高于未发生院内感染组,差异有统计学意义(t’=-10.78,P<0.0001),直接医疗经济负担DMEB增加了64.7%。校正了年龄的影响后,发生院内感染组DMEB修正均数高于未发生院内感染组,差异有统计学意义(t=-16.05,P<0.0001);以性别进行分层后,男、女性别组发生院内感染组DMEB修正均数高于未发生院内感染组,差异有统计学意义(男性:t=-12.95,P<0.0001;女性:t=-9.41,P<0.0001)。结论本研究表明院内感染增加了DMEB,因此,控制院内感染是提高医疗质量的重要环节,也是减轻患者痛苦和疾病经济负担的重要保证。

Objectives To explore the impact of nosocomial infection on direct medical economic burden （DMEB） in patients with congenital heart disease （CHD）, and to supply evidence for the value-based medicine in the clinical medicine practice. Methods With a retrospective study,2 429 CHD cases who received surgery therapy in Guangdong General Hospital from 2006 to 2008 were investigated on the DMEB. The statistical analysis was completed with SAS 9.2 software for t-test, stratification and covariance analysis. Results General nosocomial infection rate of the CHD patients was 7.00% （170/2 429）. The DMEB significantly increased by 64.7% with the occurrence of nosocomial infection （t＇ =-10.78,P〈 0.0001）. For age-adjusted, the DMEB of nosocomial infection group was still significantly higher than that of non- nosocomial infection group （t=-16.05, P〈0.0001）. For sex-stratified, the DMEB of nosocomial infection group was still significantly higher than that of non-nosocomial infection group （male ： t=-12.95, P〈0.0001 ; female ： t=-9.41, P〈0.O001 ）. Conclusions Nosocomial infection significantly increases the CHD patient＇s DMEB. To controll nosocomial infection is important for clinical improvement and DMEB reduction.