臺灣博碩士論文加值系統

本研究旨在探討結、直腸手術後之病患，其影響手術傷口感染之相關因素。本研究以兩家醫學中心向中央健康保險局所申報之次級資料，總共蒐集1851個有效樣本，資料分析利用描述性統計，無母數曼-惠特尼U檢定(Mann-Whitney U test) 及交叉表χ2檢定，篩選出兩家醫院及個別醫院影響手術傷口感染之因子，再進行對數複迴歸分析。
結果顯示：(1)在兩家醫院申報資料中，影響手術傷口感染之因子包括：手術時間、術前住院日數、住院日數、術前抗生素使用日數、術後抗生素使用日數、醫療院所、性別、術後是否使用引流管、病患來源、轉歸代碼等十項。(2)A醫院申報資料中，影響手術傷口感染之因子包括：手術時間、術前住院日數、住院日數、術前抗生素使用日數、術後是否使用引流管、轉歸代碼等六項。(3)B醫院申報資料中，影響手術傷口感染之因子包括：手術時間、術前住院日數、住院日數、術前抗生素使用日數、術後抗生素使用日數、術後是否使用引流管、病患來源、轉歸代碼等八項。經對數複迴歸分析採逐步淘汰後結果顯示：(1) 在1851個研究對象中，有138人手術後有傷口感染，(傷口感染率7.5%)，影響兩家醫院手術傷口感染重要預測因子是住院日數(OR=11.54, 95% CI=6.84-17.46)；性別(OR=.53, 95% CI=.36-.77)；醫院別(OR=.68, 95% CI=.47-.98)；手術後有否放置引流管 (OR=1.80, 95% CI=1.18-2.741)。 (2)在A醫院手術後傷口感染重要預測因子是住院日數(OR=22.07, 95% CI=8.73-55.76)。(3)在B醫院手術後傷口感染重要預測因子是住院日數(OR=6.69, 95% CI=3.49-12.81)；術前抗生素使用日數(OR=.94, 95% CI=.89-.99)；術後抗生素使用日數(OR=1.02, 95% CI=1.01-1.04)；和術後有否放置引流管(OR=2.19, 95% CI=1.24-3.88)。
建議：(1)醫療院所評鑑時應實地瞭解手術業務，排除因書面作業而產生之漏洞。(2)對於醫療院所院內感染個案要深入瞭解與改善(含設備)。(3) 對於抗生素的使用院所應訂定使用指標。

The purpose of this study is to investigate the relations risky faction between the colorectal surgery and postoperative wound infection . There were 1851 effective subjects selected from a population of the National Health Insurance (NHI) with colorectal surgeries in two hospitals of southern Taiwan. The data collected from these assessments were analyzed using the descriptive statistics , Mann-Whitney U test , cross table and stepwise multiple logistic regression analysis.
Based on the above analyse , several conclusions were reached ：(1) The relations between the colorectal surgery and postoperative wound infection include the duration of surgery, pre- operation days in the hospital , days in the hospital ,the use of days of antibiotic use in the pre- operation ,the use of days of antibiotics in the postoperative , category of hospital ,sex ,the use of drain in the postoperative , source of patient, status discharge (2) In hospital A the relations between the colorectal surgery and postoperative wound infection include the duration of surgery, pre- operation days in the hospital , days in the hospital , the use of days of antibiotics in the pre-operation , the use of drain in the postoperative , status discharge (3) In hospital B the relations between the colorectal surgery and postoperative wound infection include the duration of surgery, pre- operation days in the hospital , days in the hospital , the use of days of antibiotic use in the pre-operative , the use of days of antibiotic use in the postoperative , the use of drain in the postoperative , source of patients, status discharge .
Several conclusions were drawn by using logistic regression analysis：(1) One hundred & thirty-eight patients had surgical site infection in total 1851 surgeries ( rate per 100 surgeries : 7.45). The risk factors associated with surgical site infection were days in the hospital(OR=11.54, 95% CI=6.84-17.46)；sex(OR=.53, 95% CI=.36-.77)；Hospital A< Hospital B (OR=.68, 95% CI=.47-.98)；the use of drain in the postoperative (OR=1.80, 95% CI=1.18-2.741)。 (2) Hospital A ：the risk factors associated with surgical site infection was days in the hospital (OR=22.07, 95% CI=8.73-55.76)。(3) Hospital B ：the risk factors associated with surgical site infection were days in the hospital(OR=6.69, 95% CI=3.49 -12.81)；the use of days of antibiotic use in the pre-operative(OR=.94, 95% CI=.89-.99)；the use of days of antibiotic use in the postoperative(OR=1.02, 95% CI=1.01 -1.04)；the use of drain in the postoperative(OR=2.19, 95% CI=1.24-3.88)。

目 錄
中文摘要
英文摘要
目 錄
圖目錄
表目錄
第一章 緒 論
第一節 研究動機
第二節 研究目的
第二章 文獻探討
第一節 手術傷口感染定義
第二節 傷口的分類
第三節 影響手術傷口感染的因素
第四節 預防性抗生素的使用
第五節 引起手術傷口感染之微生物傳播途徑
第六節 手術傷口感染之預防
第三章 材料與方法
第一節 研究概念架構
第二節 研究假設
第三節 研究變項及操作型定義
第四節 研究材料
第五節 研究方法
第六節 研究進行步驟
第四章 結 果
第一節 A、B兩醫院基本資料之描述性統計本
第二節 A、B兩醫院與術後感染相關因素之描述性統計
第三節 A、B兩醫院手術後傷口感染之比較
第四節 手術後傷口感染與類別相關因素之關係
第五節 預測手術傷口感染相關因素之對數迴歸分析
第五章 討 論
第一節 手術傷口感染之比較
第二節 手術傷口感染與人口學變項
第三節 手術傷口感染與手術前、中、後之影響因素
第四節 研究限制
第六章 結論與建議
第一節 結 論
第二節 建 議
參考文獻
中文部份
英文部份
附錄
附 錄一 住院醫療費用清單明細檔
附 錄二 住院醫療醫令清單明細檔
附 錄三 全民健康保險藥品給付規定(八十九年修定版)
附 錄四 全民健康保險醫療常用第一線抗微生物製劑品名表
附 錄五 程式報表欄位一覽表

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