“五位一体”模式干预ICU患者多重耐药菌防治管理的应用研究

Application research of “five-in-one” model in the prevention and control of muti-drug resistant organisms in ICU patients

目的将"西医、中医、康复、营养、心理"五位一体模式应用于ICU多重耐药菌管控领域,旨在提高ICU管理质量,为该模式广泛应用提供参考。方法 2017年1月-2018年12月,整群抽样选择某院899例ICU患者,按入院时间分为对照组和干预组(对照组484例、干预组415例),对照组接受常规治疗,干预组在此基础上实施"五位一体"管理。收集2组多重耐药菌(MDROs)的发生率、住院时间、隔离时间、住院总费用等资料,分析"五位一体"模式的临床效益。结果干预后,ICU患者MDROs感染率(10.1%)较干预前(16.7%)明显下降(P<0.05);MDROs患者住院总费用由26.1万元减少到18.9万元;住院天数由71.3 d降至54.2 d;隔离天数由50.0 d减少到34.9 d(P<0.05)。结论 "五位一体"模式显著降低ICU多重耐药菌感染率,可缩短住院时间及隔离天数,能减少患者住院总费用;该管理模式可在临床上进一步推广。

Objective In order to improve the management quality of ICU patients,and provide a reference for the extensive clinical application of the"five-in-one model"of western medicine,traditional Chinese medicine,rehabilitation,nutrition and psychology in the prevention and control of multi-drug resistant organisms in ICU.Methods A total of 899 cases in ICU were selected by cluster sampling from January 2017 to December 2018 and divided into control group and intervention group(control group 484 cases,the intervention group 415 cases) according to admission time.The conventional treatments were applied to the control group.On the basis of conventional treatments,the intervention group also underwent the "five-in-one"model.The number of patients,length of hospital stay,length of isolation,total cost of hospital stay and other data in the two groups were collected and analyzed to research the clinical benefits of the"five-in-one"model.Results The infection rate of MDROs in ICU patients(10.1%) was significantly lower than that before the intervention(16.7%),and the difference was statistically significant(P<0.05).The average total hospital expenses of ICU MDROs patients decreased from 261 000 Yuan to 189 000 Yuan.The number of days in hospital dropped from 71.3 days to 54.2 days.The days of isolation measures decreased from 50.0 days to 34.9 days(P<0.05).Conclusion The "five-in-one"model can significantly reduce the infection rate of MDROs in ICU,shorten the hospitalization time and isolation days,and reduce the total hospitalization cost.The management model could be further promoted in hospital.