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完整後設資料紀錄
DC 欄位 | 值 | 語言 |
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dc.contributor.advisor | 楊銘欽(Ming-Chin Yang) | |
dc.contributor.author | Jian-Jhih Su | en |
dc.contributor.author | 蘇健智 | zh_TW |
dc.date.accessioned | 2021-06-13T17:30:12Z | - |
dc.date.available | 2016-10-03 | |
dc.date.copyright | 2011-10-03 | |
dc.date.issued | 2011 | |
dc.date.submitted | 2011-07-11 | |
dc.identifier.citation | 英文部分
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H., & Gaynes, R. P. (1999). Nosocomial infections in medical intensive care units in the United States. National Nosocomial Infections Surveillance System. Crit Care Med, 27(5), 887-892. Rincon-Ferrari, M. D., Flores-Cordero, J. M., Leal-Noval, S. R., Murillo-Cabezas, F., Cayuelas, A., Munoz-Sanchez, M. A., et al. (2004). Impact of ventilator-associated pneumonia in patients with severe head injury. J Trauma, 57(6), 1234-1240. Safdar, N., Dezfulian, C., Collard, H. R., & Saint, S. (2005). Clinical and economic consequences of ventilator-associated pneumonia: a systematic review. Crit Care Med, 33(10), 2184-2193. Shorr, A. F., & Kollef, M. H. (2005). Ventilator-associated pneumonia: insights from recent clinical trials. Chest, 128(5 Suppl 2), 583S-591S. Terragni, P. P., Antonelli, M., Fumagalli, R., Faggiano, C., Berardino, M., Pallavicini, F. B., et al. (2010). Early vs late tracheotomy for prevention of pneumonia in mechanically ventilated adult ICU patients: a randomized controlled trial. JAMA, 303(15), 1483-1489. Uno, H., Takezawa, J., Yatsuya, H., Suka, M., & Yoshida, K. (2007). Impact of intensive-care-unit(ICU)-acquired ventilator-associated pneumonia(VAP) on hospital mortality: a matched-paired case-control study. Nagoya J Med Sci, 69(1-2), 29-36. van Nieuwenhoven, C. A., Buskens, E., Bergmans, D. C., van Tiel, F. H., Ramsay, G., & Bonten, M. J. M. (2004). Oral decontamination is cost-saving in the prevention of ventilator-associated pneumonia in intensive care units. Critical Care Medicine, 32(1), 126-130. Warren, D. K., Shukla, S. J., Olsen, M. A., Kollef, M. H., Hollenbeak, C. S., Cox, M. J., et al. (2003). Outcome and attributable cost of ventilator-associated pneumonia among intensive care unit patients in a suburban medical center. Crit Care Med, 31(5), 1312-1317. Zack, J. E., Garrison, T., Trovillion, E., Clinkscale, D., Coopersmith, C. M., Fraser, V. J., et al. (2002). Effect of an education program aimed at reducing the occurrence of ventilator-associated pneumonia. Critical Care Medicine, 30(11), 2407-2412. Zygun, D. A., Zuege, D. J., Boiteau, P. J., Laupland, K. B., Henderson, E. A., Kortbeek, J. B., et al. (2006). Ventilator-associated pneumonia in severe traumatic brain injury. Neurocrit Care, 5(2), 108-114. 中文部分 中央健康保險局.長期使用呼吸器醫療品質指標(2011年6月引用). http://www.nhi.gov.tw/Resource/webdata/Attach_10837_1_呼吸器資訊公開.xls. 王世民. (2002). 創傷原因及分類. In 李俊仁 (Ed.), 實用外科學:總論 (pp. 8-11). 台北: Kingdom Publications Ltd. 吳肖琪, & 陳啟禎. (2004). 加護病房院內感染指標—影響呼吸器相關肺炎感染因素之探討. 臺灣公共衛生雜誌, 23(6), 440-446. 吳杰亮, & 曾政森. (2008). 呼吸器相關肺炎的適當診治. 重症醫學雜誌, 9(2), 110-116. 李枝新, 張厚台, 陳宜君, & 吳惠東. (2009). 預防呼吸器相關肺炎之實證策略. 感染控制雜誌, Vol.19 No.3 160-167. 施信嶔. (2002). 創傷生理與病理. In 李俊仁 (Ed.), 實用外科學:總論 (pp. 12-18). 台北: Kingdom Publications Ltd. 黃玉娟, 王琬詳, 謝馨樺, 鍾惠君, & 王立信. (2004). 東部某醫學中心外科加護病房呼吸器相關肺炎感染危險因子的探討. 慈濟護理雜誌, 3(3), 41-49. 廖如文, 洪培菁, 張玲華, 張秉宜, 蕭鵬卿, & 顧乃平. (2008). 以前瞻性方式探討某醫學中心外科暨神經加護中心呼吸器相關肺炎感染因子. 重症醫學雜誌, 9(4), 216-227. 蔡明哲. (2002). 呼吸道維護、輸液及監測系統. In 李俊仁 (Ed.), 實用外科學:總論 (Vol. 27-35). 台北: Kingdom Publications Ltd. | |
dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/39503 | - |
dc.description.abstract | 研究背景與目的:
呼吸器相關肺炎為醫院感染控制的重要議題之一,也是影響病人預後的一個重要併發症。本研究之目的主要是分析創傷病人罹患呼吸器相關肺炎的危險因子,並且探討呼吸器相關肺炎對創傷病人在醫療利用上可能造成的影響。 研究方法: 本研究採用國家衛生研究院所提供之全民健康保險學術研究資料庫2005年百萬承保抽樣歸人檔中2005-2007年的資料,研究樣本最後選取使用呼吸器達兩天以上之創傷病人共1,010人,其中罹患呼吸器相關肺炎者共166人。以威爾克森符號等級檢定(Wilcoxon signed-rank test)及卡方檢定作檢定,並採用逐步複迴歸及逐步羅吉斯迴歸統計方法探討創傷病人罹患呼吸器相關肺炎的危險因子及其對病人醫療利用和死亡的影響。 研究結果:創傷病人於加護病房住院期間發生呼吸器相關肺炎之發生率為16.44%;未罹患呼吸器相關肺炎的創傷病人平均加護病房住院天數為10天、總住院天數為23天、醫療費用為255,427元,罹患呼吸器相關肺炎的創傷病人平均加護病房住院天數為15天、總住院天數為32天、醫療費用為317,537元;多變項分析結果顯示年齡較大、患有敗血症、或呼吸器使用天數較長為創傷病人罹患呼吸器相關肺炎的危險因子;罹患呼吸器相關肺炎者加護病房住院天數顯著較長及總住院天數超過中位數(20天)的機會顯著較高;是否罹患呼吸器相關肺炎與醫療費用無顯著相關,但罹患的創傷病人藥費/藥事服務費用、診察/檢查/治療處置費用及病房費用占總費用的比例以及支出金額都較高;創傷病人是否罹患呼吸器相關肺炎與死亡風險無顯著相關。 研究結論: 年齡較大、罹患敗血症、或呼吸器使用天數較長為罹患呼吸器相關肺炎的危險因子;罹患呼吸器相關肺炎傾向增加創傷病人的加護病房住院天數及總住院天數,但對於醫療費用及死亡風險則無顯著影響。 | zh_TW |
dc.description.abstract | Background and objectives:
Ventilator-associated pneumonia (VAP) not only is one of the important issues of infection control, but also an important complication affecting patients’ prognosis. The main purpose of this research is to analyze the risk factors of trauma patient with VAP and the association with medical care utilization. Methods: Data came from claims data file of 100 million sampled registry from Taiwan National Health Insurance Research Database from 2005 to 2007. A total of 1,010 trauma patients who received invasive mechanical ventilator for >48 hours were analyzed in this study. Differences were compared by using Wilcoxon signed-rank test and Chi-square test; Risk factors for VAP and assciation with medical care utilization were examined by using logistic regression and multiple linear regression. Results: Of the total of 1,010 patients, 166 (16.44%) developed VAP during hospitalization. Logistic regression analysis showed that age > 65, having sepsis and having longer duration of mechanical ventilation were factors associated with developing VAP. Trauma patients with VAP had significantly longer ICU stay (15 versus 10, P<0.001), and hospital stay (32 versus 23, P<0.001), and higher health care expenditure (NT$317,537 versus NT$255,427, P<0.001). Multiple linear regression analysis indicated that VAP significantly prolonged trauma patients’ ICU stay and hospital stay, but didn’t significantly increase patients’ expenditure and mortality rate after controlling for other factors. Conclusions: Age>65, suffering sepsis or long duration of mechanical ventilation were risk factors for developing VAP for trauma patients. VAP was associated with patients’ ICU stay and hospital stay. | en |
dc.description.provenance | Made available in DSpace on 2021-06-13T17:30:12Z (GMT). No. of bitstreams: 1 ntu-100-R98843007-1.pdf: 1682453 bytes, checksum: f060b8788cbcc51e2740875e61b022a3 (MD5) Previous issue date: 2011 | en |
dc.description.tableofcontents | 第一章 緒論 1
第一節 研究背景與動機 1 第二節 研究目的 2 第二章 文獻探討 3 第一節 呼吸器相關肺炎的流行病學 3 第二節 創傷之簡介及其和呼吸器相關肺炎之關聯 8 第三節 相關實證研究 10 第四節 綜合討論 18 第三章 研究材料與方法 19 第一節 研究架構 19 第二節 研究假說 20 第三節 研究變項 21 第四節 研究材料及對象 25 第五節 資料處理與統計分析 26 第四章 研究結果 30 第一節 描述性統計 30 第二節 雙變項分析 35 第三節 多變項分析 37 第五章 討論 57 第一節 研究結果之討論 57 第二節 假說驗證 66 第三節 研究限制 68 第六章 結論與建議 69 第一節 結論 69 第二節 建議 71 參考文獻 73 附 錄 80 | |
dc.language.iso | zh-TW | |
dc.title | 創傷病人罹患呼吸器相關肺炎之危險因子與醫療利用 | zh_TW |
dc.title | The Risk Factors and Utilization of Trauma Patient with Ventilator-Associated Pneumonia (VAP) | en |
dc.type | Thesis | |
dc.date.schoolyear | 99-2 | |
dc.description.degree | 碩士 | |
dc.contributor.oralexamcommittee | 周穎政(Ying-Jenq Chou),林恆慶(Herng-Ching Lin) | |
dc.subject.keyword | 呼吸器相關肺炎,創傷,全民健康保險, | zh_TW |
dc.subject.keyword | ventilator-associated pneumonia,trauma,National Health Insurance, | en |
dc.relation.page | 82 | |
dc.rights.note | 有償授權 | |
dc.date.accepted | 2011-07-11 | |
dc.contributor.author-college | 公共衛生學院 | zh_TW |
dc.contributor.author-dept | 健康政策與管理研究所 | zh_TW |
顯示於系所單位: | 健康政策與管理研究所 |
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