使用呼吸器併發肺炎對於長期使用呼吸器病患醫療照護之影響：一項來自於全國醫療照護給付資料庫之分析結果

Impact of ventilator-associated pneumonia on medical care among patients with pro-longed mechanical ventilation- evidence from a nationwide claims database analysis

背景和目的：長期使用呼吸器與重度使用醫療資源、入院和出院死亡率有關。使用呼吸器併發肺炎是長期使用呼吸器病患最常見的感染症。本研究是使用台灣地區全民健康保險研究資料庫來評估使用呼吸器併發肺炎對於長期使用呼吸器病患醫療照護的影響。方法：本研究為重疊病例對照研究。病例組是長期使用呼吸器病患於2000年1月1日至2010年12月31日期間(研究期間)，被診斷為呼吸器併發肺炎的新病例(共2,248位)。對照組是長期使用呼吸器於研究期間未被診斷為呼吸器併發肺炎的病患(共2,248位)。本研究使用條件式羅吉斯迴歸分析，以勝算比和95%信賴區間來評估長期使用呼吸器是否合併呼吸器併發肺炎對於醫療照護的影響。結果：相較於長期使用呼吸器未合併呼吸器併發肺炎之病患，長期使用呼吸器合併呼吸器併發肺炎之病患有較高之收入迴轉加護病房的風險(勝算比:1.27;95%信賴區間：1.12-1.45)，較容易收入居家照護(勝算比:2.00;95%信賴區間：1.38-2.90)，以及有較高之收入呼吸照護病房的風險(勝算比:2.01;95%信賴區間：1.76-2.30)。結論：整體而言，長期使用呼吸器合併呼吸器併發肺炎之病患，需要持續性與密集的醫療照護。本研究結果對於長期使用呼吸器病患之醫療照護提供臨床實證研究的證據。本研究結果需要後續追蹤研究的驗證。

 

Background and Purpose: Prolonged mechanical ventilation (PMV) is associ-ated with a disproportionate use of intensive care units and hospital resources and high in-hospital and postdischarge mortality. Ventilator-associated pneumonia (VAP) is one of the most common infections in patients requiring PMV. Objectives: This study analyzed real-world data from Taiwan’s National Health Insurance Research Database to evaluate the impact of VAP on medical care among patients with PMV. Methods: This study was a nested case-control study. Cases were PMV patients with newly diagnosed pneumonia (n=2,248) and controls were PMV patients without com-plicated pneumonia (n=2,248). Odds ratios (ORs) and 95% confidence intervals (CIs) derived from conditional logistic regression models were used to evaluate the impact of PMV with or without pneumonia on medical care. Results: Cases with VAP was associated with a significantly higher risk of admission to rotary ICU (adjusted OR, 1.27; 95% CI, 1.12-1.45), return down home care (adjusted OR, 2.00; 95% CI, 1.38-2.90), and return down respiratory care ward (adjusted OR, 2.01; 95% CI, 1.76-2.30), as compared with controls with non-pneumonia PMV. Conclusion: This study demonstrates that VAP might be a crucial factor for medical care among pa-tients with PMV. Our results are highly clinically relevant for the management of pa-tients with PMV. Future prospective studies is warranted to validate our findings.