影響台灣離島地區插管病人呼吸器脫離之相關因素

Factors Associated with Ventilator Weaning in Intubated Patients of Taiwan's Offshore Islands

10.6142/VGHN.202103_38(1).0002

陳俊宇(Chun-Yu Chen)；尹玓(Ti Yin)；梁淑媛(Shu-Yuan Liang)；劉介宇(Chieh-Yu Liu)

預測因子 ； 呼吸器脫離 ； 離島地區 ； 身體質量指數 ； predictors ； ventilator weaning ； offshore islands ； body mass index(BMI)

榮總護理

38卷1期（2021 / 03 / 01）

14 - 25

繁體中文

影響呼吸器病人脫離呼吸器的因素甚多，臨床上的脫離預測指標眾說紛云，但脫離呼吸器並非百分之百成功，如果能在現行的呼吸器脫離預測指標外增加其他的預測性項目，相信更能準確地掌握呼吸器脫離的時機。探討插管病人呼吸器脫離成功之預測因子。採橫斷式研究方便取樣方式，以離島某地區教學醫院加護病房插管病人共60位為研究對象，以病歷回顧及測量工具收集資料，以t檢定、Mann-Whitney U檢定、卡方檢定及羅吉斯迴歸進行資料分析。研究顯示不同呼吸器脫離結果在身體質量指數（Body Mass Index, BMI）（t=-3.47, p= .001）、加護病房停留天數（Z=-2.49, p= .013）、入加護病房時疾病嚴重度（Z=-2.76, p= .006）、呼吸器脫離前疾病嚴重度（t=2.83, p= .006）、呼吸音分布（p= .004）、HCO_3^-（t=2.28, p=.026）、BE（t=2.65, p= .010）、最大吸氣壓（Z=-2.31, p= .021）有顯著差異。呼吸器脫離成功的最佳預測因子是BMI，總正確率最高為80.0％，敏感度為95.7％，特異性為28.6％，陽性預測值為81.5％，陰性預測值為66.7％。BMI、加護病房停留天數及呼吸器脫離前疾病嚴重度的組合則總正確率上升至85.0％，93.5％的敏感度，57.1％的特異性，87.8％的陽性預測值和72.7％的陰性預測值。BMI、加護病房停留天數及呼吸器脫離前疾病嚴重度決定了插管病人呼吸器脫離的結果。

Ventilator weaning is not always successful, and many factors influence its success. Clinically, these indicators are not entirely distinct. The use of predictive indicators of ventilator weaning along with other predictive projects can enable the attainment of a more accurate understanding of the optimal timing for ventilator weaning. We adopted a cross-sectional design with convenience sampling to investigate the predictors of successful weaning. A total of 60 patients were recruited from the intensive care units (ICUs) of teaching hospitals on one of Taiwan's offshore islands. We collected data by using measurement tools and reviewing patients' medical records, and a t test, the Mann-Whitney U test, a chi-square test, and logistic regression were used to analyze data. The results indicated that ventilator weaning results differed significantly according to body mass index (BMI) (t=-3.47, p= .001), ICU stay (Z=-2.49, p= .013), Acute Physiology And Chronic Health Evaluation II (APACHE II) score at admission (Z=-2.76, p= .006) and before weaning (t=2.83, p= .006), breathing sounds (p= .004), HCO_3^- level (t=2.28, p= .026), BE (t=2.65, p= .010), and Pimax (Z=-2.31, p= .021). The best predictor of successful weaning was BMI, with 80.0% accuracy, 95.7% sensitivity, 28.6% specificity, 81.5% PPV, and 66.7% NPV. The combined use of BMI, ICU stay, and APACHE II before weaning increased these values to 85.0% accuracy, 93.5% sensitivity, 57.1% specificity, 87.8% PPV, and 72.7% NPV. Doctors could use BMI, ICU stay, and APACHE II before weaning to more accurately determine the outcomes of ventilator weaning among patients under intubation.

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