CAJ | 학술논문

目的：探讨多准则决策分析（MCDA）在重症肺炎集束化治疗中的作用。方法采用与历史对照的前瞻性观察性研究方法，以2013年1月至2014年8月徐州医学院第二附属医院呼吸内科收治的75例重症肺炎患者作为前瞻性干预组，由医护人员组成MCDA小组，根据MCDA评估结果选取集束化治疗措施与抗感染、化痰等常规治疗措施组成捆绑式治疗方案，并随时进行调整，直至患者转出呼吸重症加强治疗病房（RICU）或死亡。以2010年8月至2012年12月呼吸内科收治的70例重症肺炎患者作为历史对照组。比较两组患者治疗前基线资料及治疗期间院内感染（院感）发生率、人均住院费用、RICU住院时间及病死率。结果两组患者治疗前性别、年龄、基础疾病、入院时急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分等比较差异均无统计学意义，有可比性。与对照组相比，干预组治疗期间院感发生率明显下降〔1.33%（1/75）比11.43%（8/70），χ2＝4.723，P＝0.030〕，RICU住院期间人均住院费用明显下降（万元：3.44±0.79比3.76±0.91，t＝2.265，P＝0.025），RICU住院时间明显缩短（d：15.01±4.22比16.92±4.79，t＝2.552，P＝0.012）、RICU病死率明显下降〔8.0%（6/75）比21.4%（15/70），χ2＝5.272，P＝0.032）。结论 MCDA应用于构建重症肺炎的集束化管理，提高了决策的科学性，降低了个体医疗费用，达到了落实指南、改善患者临床结局和预后的目的。
목적：탐토다준칙결책분석（MCDA）재중증폐염집속화치료중적작용。방법채용여역사대조적전첨성관찰성연구방법，이2013년1월지2014년8월서주의학원제이부속의원호흡내과수치적75례중증폐염환자작위전첨성간예조，유의호인원조성MCDA소조，근거MCDA평고결과선취집속화치료조시여항감염、화담등상규치료조시조성곤방식치료방안，병수시진행조정，직지환자전출호흡중증가강치료병방（RICU）혹사망。이2010년8월지2012년12월호흡내과수치적70례중증폐염환자작위역사대조조。비교량조환자치료전기선자료급치료기간원내감염（원감）발생솔、인균주원비용、RICU주원시간급병사솔。결과량조환자치료전성별、년령、기출질병、입원시급성생이학여만성건강상황평분계통Ⅱ（APACHEⅡ）평분등비교차이균무통계학의의，유가비성。여대조조상비，간예조치료기간원감발생솔명현하강〔1.33%（1/75）비11.43%（8/70），χ2＝4.723，P＝0.030〕，RICU주원기간인균주원비용명현하강（만원：3.44±0.79비3.76±0.91，t＝2.265，P＝0.025），RICU주원시간명현축단（d：15.01±4.22비16.92±4.79，t＝2.552，P＝0.012）、RICU병사솔명현하강〔8.0%（6/75）비21.4%（15/70），χ2＝5.272，P＝0.032）。결론 MCDA응용우구건중증폐염적집속화관리，제고료결책적과학성，강저료개체의료비용，체도료락실지남、개선환자림상결국화예후적목적。
ObjectiveTo determine the effect of multi-criteria decision analysis (MCDA) on the effect of bundle treatment for severe pneumonia.Methods A prospective historical control observation was conducted. Seventy-five patients with severe pneumonia having received MCDA (from January 2013 to August 2014) were assigned as intervention group. MCDA group was set up by the medical staff. Bundled treatment plan was composed of the MCDA evaluation results, anti-infection, phlegm and other conventional treatment measures which was adjust on time until the patient was transferred out of the respiratory intensive care unit (RICU) or died. Seventy patients with severe pneumonia before receiving MCDA (from August 2010 to December 2012) were set as historical control group. Comparison of general condition before treatment and the incidence of hospital infection, average hospitalization cost, duration of RICU stay and mortality between these two groups were performed.Results There were no statistically significant differences in gender, age, past history, and acute physiology and chronic health evaluationⅡ (APACHEⅡ) score at admission between two groups. Compared with control group, the incidence of hospital infection [1.33% (1/75) vs. 11.43% (8/70),χ2 = 4.723,P = 0.030], mean hospitalization cost in RICU (10 thousand Yuan: 3.44±0.79 vs. 3.76±0.91,t = 2.265, P = 0.025), length of RICU stay (days: 15.01±4.22 vs. 16.92±4.79,t = 2.552,P = 0.012) and mortality in RICU [8.0% (6/75) vs. 21.4% (15/70),χ2 = 5.272,P = 0.032] in intervention group was significantly decreased. Conclusions Application of MCDA in the bundle treatment of severe pneumonia could elevate the scientificalness of decision, and reduce the medical cost. Additionally, MCDA is worth to be generalized because the implementation of guidelines can improve the clinical outcome and prognosis of the patients.