比較不同透析方式病人發生感染之危險性與相關因素

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Title:	比較不同透析方式病人發生感染之危險性與相關因素 Comparison of the relative risk of different dialysis modalities on the occurrence of infection and its associated factors
Authors:	蕭肜妤;Chen-Yu Hsiao
Contributors:	公共衛生學院醫務管理學研究所碩士班
Keywords:	血液透析;腹膜透析;感染;hemodialysis;peritoneal dialysis;infection
Date:	2010
Issue Date:	2010-09-29 12:05:54 (UTC+8)
Abstract:	目的：透析病人因自體免疫及治療方式導致感染風險高於常人，但鮮少研究針對不同透析方式發生感染進行比較，故本研究將探討不同透析方式之感染情形及影響透析病人發生感染之相關因素，期對透析方式之選擇有所助益。方法：本研究屬回溯性研究，採世代研究，以1997 ~2007年全民健保資料庫，初次接受透析三個月以上之80,855位病人為研究對象，比較2000年~2007年在病人特性、機構特性、醫師特性及透析方式等方面感染情形是否有差異。應用Cox proportional hazards model探討影響透析病人感染之相關因素。結果：研究發現透析病人之平均年齡為61歲，94.21%為血液透析病人、5.79%為腹膜透析病人，2000年~2007年期間81.94%有感染。而血液透析病人有82.10%有感染，腹膜透析則為79.55%。由Cox proportional hazards model分析得知，顯著影響透析病人有無感染之主要因素有病人之「性別」、「年齡」、「都市化程度」、「家戶所得程度」、「醫師性別」、「醫師年齡」、「醫師透析病人量」、「醫院層級」、「醫院權屬別」、「醫院透析人數」、「透析方式」與「合併疾病」。其中腹膜透析病人感染的相對風險為血液透析之0.902倍(95%CI：0.872-0.932)、醫學中心層級之透析病人感染風險相較基層診所高，醫學中心為基層診所之1.584倍(95%CI：1.571-1.597)，且當醫院層級愈高，其感染比率愈高。結論及建議：本研究發現血液透析病人之感染風險較腹膜透析高；而病人特性、主要照護病人之機構特性、病人之主要照護醫師特性及其本身之合併症皆會影響透析病人感染情形，是以可藉由上述影響因素，透過衛教提升病人自我照護能力與知識，減少病人特性所造成的感染，並加強醫療人員感控措施，減少透析病人之院內感染情況發生。 Objectives：Dialysis patients are prone to infection due to their immune deficiency. However, very few studies focused on the influence of different dialysis modalities on the occurrence of infection. Therefore, this study will compare the infection risks in patients receiving different dialysis modalities. The results may be useful for choosing dialysis modality. Method：This is a retrospective cohort study. We collect 80,855 patients who had received dialysis for at least three months from National Health Insurance database during 1997 to 2007. Using Cox proportional hazards model, we analyze the influences of patient characteristics, facility characteristics, physician characteristics and dialysis conditions on the risk of infection in dialysis patients during 2000 to 2007. Results：The average age of these patients was 61 years old. 94.21 percent patients received hemodialysis and 5.79% received peritoneal dialysis. During the period from 2000 to 2007, 81.94 percent patients got infection. 82.10% hemodialysis patients got infection, compared with 79.55% in peritoneal dialysis patients. From the analysis by Cox proportional hazards model, factors influencing risk of infection that reached statistically significant difference (P<0.05) were patient gender, age, degree of urbanization, city household income level, physician gender, age, the number of dialysis patients of physician, hospital level, hospital ownership status, the number of dialysis patients of hospital, dialysis modalities and complications. Compared to hemodialysis patients, the relative risk of infection in peritoneal dialysis patients was 0.902(95% CI: 0.872-0.932). Patients who received dialysis in medical centers had higher risk of infection than those in primary care clinics. The hazard ratio was 1.584(95% CI: 1.571-1.579). In addition, the higher the hospital level, the higher is the probability of infection. Conclusions：Our study showed that hemodialysis patients had high risk of infection than peritoneal dialysis patients. Besides, factors such as patient characteristics, facility characteristics, physician characteristics and patient complications had significant influence on the infection risk of dialysis patients. Therefore, according to our study results, we can increase the patient self-care ability by medical instruction guildances, decrease the infection possibility caused by patient characteristics and enhance the infection control procedure of medical staffs to reduce the infection risk in the hospital of dialysis patients.
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