老年胃癌术中腹腔化疗对医院感染的影响及经济负担

Influence of intraoperative abdominal chemotherapy on nosocomial infection in elderly patients with gastric cancer and economic burden

目的 通过对老年胃癌患者医院感染现状进行调查,探讨术中行腹腔化疗与医院感染的相关性,评估此类患者因医院感染导致的经济负担。方法 将2018年1月1日-12月31日某三级甲等综合医院收治的所有符合纳入标准的老年胃癌手术患者作为研究对象,运用自行设计的调查表收集患者临床资料,对老年胃癌患者医院感染现状进行分析;采用倾向评分匹配法进行1∶1匹配,分析术中行腹腔化疗的老年胃癌患者因医院感染导致的经济负担情况。结果 纳入符合条件的老年胃癌术后患者180例,术后发生医院感染29例,感染率为16.11%;腹腔引流管留置天数、术中行腹腔化疗是老年胃癌患者术后发生医院感染的独立危险因素(P<0.05);术中行腹腔化疗的老年胃癌患者因感染造成的经济负担为35 119.11元/例(Z=-3.756,P<0.001),其中西药费造成的经济负担最大。结论 术中行腹腔化疗一定程度上增加了老年胃癌患者发生医院感染的风险,且因医院感染造成的经济负担需要引起高度重视。

OBJECTIVE To conduct a survey for prevalence of nosocomial infection in elderly patients with gastric cancer, explore the association between intraoperative abdominal chemotherapy and nosocomial infection, and assess the economic burden due to the nosocomial infection. METHODS From Jan 1, 2018 to Dec 31, 2018, the elderly patients with gastric cancer who underwent surgery in a three-A tertiary hospital and were eligible for inclusion criteria were recruited as the study subjects. The clinical data were collected from the patients by using self-designed questionnaire, the prevalence of nosocomial infection was analyzed, a 1∶1 matching was carried out by using tendency score matching method, and the nosocomial infection-induced economic burden of the elderly patients with gastric cancer was observed. RESULTS Of totally 180 elderly patients with gastric cancer who met the inclusion criteria, 29 had postoperative nosocomial infection, with the infection rate 16.11%. The duration of abdominal drainage tube indwelling and intraoperative abdominal chemotherapy were the independent risk factors for the postoperative nosocomial infection in the elderly patients with gastric cancer(P<0.05).The economic burden due to the infection was 35119.11 yuan per case(Z=-3.756,P<0.001), and the economic burden of western medicine was the greatest. CONCLUSION The intraoperative abdominal chemotherapy to some extent increases the risk of nosocomial infection in the elderly patients with gastric cancer, and the economic burden due to the nosocomial infection should be attached great importance to.