中心靜脈導管已成為外科加護重症病房常規必用且不可或缺的衛材。外科重症病患不僅需要多項靜脈藥物投予，以控制病情，也須持續監測血行動力狀態，以防止血壓不穩危及生命。中心靜脈導管內含多條管腔的設計，可同時架接多項藥物或輸液，亦能連結壓力導管進行持續血行動力監測。雖然中心靜脈導管的問世對加護照顧貢獻許多好處，然而中心靜脈導管引發的血流感染，也增加外科重症病患的併發症與死亡率，成為目前外科重症加護照顧的重要議題。
近年推動的「中心靜脈導管強力感控計畫」確實降低了中心靜脈導管相關血流感染的發生率，中心靜脈導管相關血流感染的發生率也被用來當作重症加護照顧的品質指標之一。不過導管強力感控照顧無法保證零管路感染率，而發生率又屬於落後指標，因此對於血流感染所可能誘發的敗血症與高死亡率並無預測及防治的功能。為求有效抑制中心靜脈導管相關血流感染的發生，有害因素的篩檢與審視理應放在病程的早期進行，亦即需尋求一個可靠的領先指標，才能對中心靜脈導管相關之血流感染的防治更有幫助。
本研究利用「事件衍生時序」的模型來檢視與導管相關血流感染的風險因子，企求找出與中心靜脈導管感染和後續死亡具有強相關的預測因子。根據前置研究已歸納出七個參數作為分析探討的預測因子，包括年齡、性別、疾病急性心肺生理功能指數(疾病嚴重度;APACHE II score)、共病症指標(Charlson comorbidity index)、非計畫性住院、器官移植、與高脂肪輸液投予。研究場域則選擇南部某教學醫院外科加護病房，因為其環境條件和人員技能上都較具一致的水準，研究對象則將所有接受中心靜脈導管置入的外科加護病房患者收錄。本研究亦探討中心靜脈導管相關血流感染對醫院營運上的衝擊影響，分析參數有二：直接參數取之於每位病患的醫療花費;間接參數則是病患於醫院和加護病房的住院天數。
從本研究分析中發現，疾病嚴重度(APACHE II score)超高的病人最易遭受中心靜脈導管相關血流感染;這些病人通常在入院時都呈現瀕死危象，例如休克、心跳停止或心肺急救等，其死亡率不論在治療的早期或晚期都較一般病患有比值性的爆增。由推論統計分析，入院呈現瀕死危象的族群，不論在中心靜脈導管相關血流感染、加護病房死亡、住院中死亡或九十天死亡，都表現極強的統計相關性。因此，若能將瀕死危象的病程解析更為透徹，一符合臨床實用的領先指標將可確立。研究也顯示中心靜脈導管相關血流感染確實會嚴重影響醫院的收益─如暴增的特殊醫材與藥品管理成本，加護病房及醫院的病床占用率因超長住院天數而增高，大量人員與設備消耗及滯用於少數病患，在在都會侵蝕醫院的整體營收。

Central venous catheter (CVC) has become an indispensable device in critical care for patients of surgical intensive unit (SICU). SICU patients need not only synergistic multi-drugs treatment but also continuous hemodynamic monitoring. Delicate design of CVC allows above requirements to be fulfilled simultaneously. Even though CVC merits critical care greatly, device-related infection may nevertheless lead to severe blood stream infection. ICU morbidity and mortality may therefore burst out increasing. Hence, catheter-related bloodstream infection (CRBSI) emerges as a crucial matter for SICU care.
Occurrence of CRBSI could actually be reduced by rigorously conducting CVC bundle care. Incidence of CRBSI has been therefore proposed as one quality indicator of SICU care. However, meticulous CVC care doesn’t promise “zero” CRBSI. As a lagging indicator, incidence cannot predict and preclude CRBSI-associated mortality and sepsis. To effectively inhibit the happening of CVC-RBSI, hazard etiologies should be scrutinized at earlier stage of illness. As a result, finding out a useful leading indicator may be superior on the management of CVC-RBSI.
Our study took advantage of “time-to-event” model to inspect the risk factors related to CVC-RBSI. We attempted to figure out those predictors with strong correlation to CVC infection and subsequent mortality. According to pilot studies, seven parameters including age, gender, APACHE II score, Charlson comorbidity index, organ transplantation, unscheduled admission and use of parenteral fat emulsion were selected as the analyzed predictors. SICU of National Cheng Kung University Hospital was chosen as the study setting because of well-conditioned environment and staff capacity. All SICU patients receiving CVC insertion were recruited as the study subjects. In addition to finding correlated predictors, impacts of CVC-RBSIs on hospital administration were also investigated (post-event study). Direct cost of healthcare as well as indirect consumption coming from hospital and ICU stay were exploited to assess the impacts of CVC-RBSIs.
From our surveillance, patients with extremely high APACHE II score, particularly those presented lethal crises (e.g. shock, cardiac arrest and CPCR) on admission, would readily suffer CVC-RBSIs. Their mortality rate, either early or late death, would be exponentially increased. By statistical analysis, lethal crises on admission also demonstrated very strong correlation to CVC-RBSI and mortality of ICU, in-hospital and 90-day. We think that a practical leading indicator may be established if pathogenesis of lethal crises on admission can be further clarified.
Our study also revealed CVC-RBSIs would deeply impact the hospital revenue. Abrupt cost expansion as well as over-prolonged ICU and hospital stay would further decrease the overall profit. Optimal strategy to deal with CVC-RBSIs, therefore, should be deliberately designed.

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