| Part one Investigation on undernutrition and nutrition support in patients with nosocomial infectionObjective:In this study,through retrospective analysis of case information of patients with nosocomial infections,Understand the occurrence of undernutrition and nutrition support applications.In order to further improve the nutritional status of patients with nosocomial infections and provide standardized and reasonable nutritional care to provide clinical reference materials.Methods:A total of 970 cases of nosocomial infections were collected in the First Hospital of Hebei Medical Univers ity from January 1,2016 to January 1,2017.By looking through the medical records,using self-designed"case reports of patients with nosocomial infections,"to collect relevant information.All data were analyzed using SPSS 21.0 statistical software.Describe the counting data using frequency,composition ratio or percentage;describe the measurement data that satisfy the normal distribution in the form of meanąstandard deviation;otherwise,use the median(interquartile range)for description.Comparison between different groups using chi-square test.?=0.05 as the test level.Result:1.The inc idence of undernutrition in patients with nosocomial infection was 50.82%(493/970).The highest inc idence was respiratory medic ine,accounting for 73.85%(48/65).The lowest incidence was urology,accounting for 12%.The incidence of undernutrition between departments has a statistically significant difference(?~2=100.103,P=0.000).2.The nutritional support rate of nosocomial infection patients with undernutrition in different departments was different.The highest nutritional support rate of neurosurgery was 97.44%,and the lowest was nephrology and urology,which are zero.3.The incidence of undernutrition among nosocomial infection patients older than 70 years old was higher than that younger than 70 years(63.79%vs44.99%,P=0.000).The nutritional support rate of nosocomial infection patients with undernutrition older than 70 years old was also higher than that of patients younger than 70 years old(59.90%vs 50.17%,P=0.035).4.There was a gender difference in the incidence of undernutrition in patients with nosocomial infection,which was significantly higher in male patients than in female patients(54.89%VS 44.70%,P=0.002).However,there was no gender difference in the rate of nutritional support among them(P>0.05).5.The nutritional support rate of undernourished hospital-acquired patients with different payment methods varied from 69.77%for provincial medical insurance to 50.91%for urban medical insurance to 47%new rural cooperative medical care for and 41.23%for self-payment.The difference was statistically significant(?~2=17.082,P=0.001).Conclusion:1.The inc idence of undernutrition in patients with nosocomial infections is high,there are differences between different departments,The inc idence o f undernutrition was higher in patients older than 70 years.And male patients are higher than female patients.2.Different sections of undernourished patients with nosocomia l infections nutritional support rate is different,patients older than 70 years have a greater chance of receiving nutritional support,different payment methods affect the patient's nutritional support decision-making.Part two Impact of Nutritional Support on Clinical Outcomes and Direct Economic Loss in Patients with Nosocomial InfectionsObjective:In this study,a 1:1 matching case-control study was conducted to analyze the effect of nutritional support on the clinical outcome and direct economic loss of undernourished patients with nosocomial infections in order to clarify the clinical significance of nutritional support for patients with nosocomial infections nosocomial infections and how provide a theoretical basis for the nutritional nurs ing of patients with nosocomial infections.Methods:493 cases of undernourished patients with nosocomial infections were divided into nutritional support group and non-nutritional support group according to whether they received nutritional support.Among them,there are 266 cases of nutritional support and 227 cases of non-nutritional support.The two groups were paired according to the pairing conditions.Matching conditions:The same hospitalization,the first diagnosis of the same disease,the same billing method,the same CCI score,age?5 years old,the same sex,the same infection site 1:1 matching,a total of 124 pairs of successful match.All collected data were statistically analyzed by SPSS 21.0 statistical software.Describe the counting data using frequency,composition ratio or percentage;describe the measurement data that satisfy the normal distribution in the form of mean?standard deviation;otherwise,use the median(interquartile range)for description.Comparison of measurement data using rank sum test,count data comparison using chi-square test.Bilateral test?=0.05 as the test level.Result:1.A total of 248 patients were enrolled,according to the pairing conditions effective matching 124 pairs,that is,each group of 124 cases.They are 64 males and 60 females.The median age of the nutrition support group was 65 years,the interquartile range was 25 years,the median age o f the non-nutrition support group was 69 years,and the interquartile range was 29years.124 pairs patients,at least two parts of the infection occurred in 10 pairs patients,simple upper respiratory tract infection in 22 pairs cases,simple lower respiratory tract infection in 62 pairs cases,simple urinary tract infection in 16 pairs cases,simple intestinal infection in 8 pairs cases,other infections in 6 pairs cases.2.The median total cost of hospital admissions for patients in the nutrition support group was 41328.2 RMB.The median total cost of hospitalization for those without the nutritional support group was47723.29RMB,about 6000 RMB more than the patients in the nutritional support group.However,by rank sum test,the difference was not statistically significant(P>0.05).3.Patients in the nutrition support group had a median hospital stay of 31days compared with 40 days in the non-nutrition support group and 9 days longer than the nutrition support group.The rank sum test,the difference between the two groups of patients was statistically significant(Z=2.205,P=0.027).4.The median cost of antimicrobial drugs in patients with nutrition support group was 2,366 RMB,while the median of antimicrobial drugs in patients without nutritional support group was 3,723.46 RMB,an increase of1,357.46 RMBmore than those with nutritional support group.The rank sum test,the difference between the two groups of patients was statistically significant(Z=2.205,P=0.027).5.The median number of days of antibiotic use among patients in the nutrition support group was 9 days,while the median number of days of antibiotic use in the non-nutrition support group was 13 days,an increase of 4days compared with the nutrition support group.By rank sum test,the difference between the two groups of patients was statistically significant(Z=3.086,P=0.002).6.The two groups used the most restrictive antibacterials,accounting for70.97%(the nutrition support group)and 61.29%(the non-nutrition support group).respectively.Followed by non-restricted antibacterials,both were20.97%.The use of special antimicrobials was relatively low,at 8.06%(the nutrition support group)and 17.74%(the non-nutrition support group)respectively.However,after statistical analys is,the difference between the two groups was not statistically significant(P>0.05).7.There was no significant difference in the frequency of infection between the two groups(P>0.05).However,the incidences of secondary and secondary infections in the nutrition support group were 9.68%,much lower than those in the non-nutrition support group(16.13%).Conclusion:1.The use of nutritional support for undernourished patients with nosocomial infections can shorten the length of stay and,to some extent,reduce total cost of hospitalization.2.The application of nutrition support reduces the days and cost of antibacterial drug use in undernourished patients with nosocomial infections,shortens the time for anti-infective treatment and saves the medical cost.3.Active and reasonable nutritional support for undernourished patients with nosocomial infections has a positive impact on improving patient outcomes. |
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