重症监护病房呼吸机相关性肺炎患者住院费用影响因素的通径分析

目的探讨影响重症监护病房(ICU)呼吸机相关性肺炎(VAP)患者住院费用的影响因素,为减轻ICU并发VAP患者经济负担,合理控制医疗费用提供依据.方法于2017年6月~2019年6月,对黔南州人民医院入住ICU采取机械通气治疗并发VAP的216例患者进行通径分析,记录每例患者临床资料.采用逐步回归法,以住院费用、住院天数为内生变量,拟合通径分析模型,探讨影响住院费用的直接效应及间接效应.结果增加ICU并发VAP患者的住院费用主要影响因素为住院时间,其次分别为机械通气时间、ICU住院时间、抗菌药物使用时间、年龄、并发症、APACHEⅡ评分、手术治疗联用抗菌药物、补充白蛋白.其中手术治疗、机械通气时间、ICU住院时间还通过住院天数间接增加ICU并发VAP患者住院费用,而年龄通过住院天数间接减少ICU并发VAP患者住院费用(P<0.05),总效应为依次增加ICU并发VAP患者住院费用的因素为住院时间、机械通气时间、ICU住院时间、抗菌药物使用时间、年龄、APACHEⅡ评分、并发症、手术治疗、联用抗菌药物、补充白蛋白.结论应合理缩短不必要的ICU住院时间、机械通气时间与总住院时间,早期拨管,严格白蛋白等贵重药品的规范使用,合理使用抗菌药物等为主的综合措施,最大限度充分合理利用卫生资源,降低ICU并发VAP患者的经济负担.

Path analysis of influencing factors on hospitalization expenses of patients with ventilator-associated pneumonia in intensive care unit

Objective To explore the influencing factors of hospitalization expenses of ventilator-associated pneumonia(VAP)patients in intensive care unit(ICU),so as to provide evidence for reducing the economic burden of the patients by rationally controlling their medical expenses.Methods From June 2017 to June 2019,216 patients admitted to the ICU of Qiannan People’s Hospital with mechanical ventilation and VAP were analyzed,and the clinical data of each patient were recorded.Using forward stepwise regression method,and hospitalization cost and hospitalization days as endogenous variables,the direct and indirect effects on hospitalization costs were investigated with fitting path analysis model.Results The main influencing factors of increased hospitalization cost of patients with VAP in ICU were length of stay,followed by mechanical ventilation time,length of stay in ICU,duration of antibiotic use,patient age,complications,APACHE II score,and combined use of antibiotics and albumin supplementation.Among them,surgical treatment,mechanical ventilation time and ICU stay also indirectly increased the hospitalization costs of ICU patients with VAP because of increased hospitalization days.Age indirectly reduced the hospitalization cost of patients because of short hospital stay(P<0.05).The overall effect on the hospitalization cost of patients with VAP in ICU included hospitalization days,mechanical ventilation time,ICU stay,antibiotic use,age,APACHE II score,complications,surgical treatment,and combined use of antibiotics and albumin supplementation.Conclusion Comprehensive measures should be taken,such as shortening unnecessary ICU stay,mechanical ventilation time and total hospitalization time,early extubation,standardized use of costly drugs such as albumin,and rational use of antibiotics to make full and rational use of health resources and reduce the economic burden of patients with VAP in ICU.