亞急性呼吸照護中心實施呼吸器脫離計劃之效益

Effects of the Ventilator Weaning Protocol in the Respiratory Care Center

10.6320/FJM.202007_24(4).0002

吳緒慧(Hsu-Huei Wu)

亞急性呼吸照護中心 ； 呼吸器脫離計劃 ； 人工氣道 ； respiratory care center ； ventilator weaning protocol ； airway management

台灣醫學

24卷4期（2020 / 07 / 25）

356 - 370

繁體中文

本研究為回溯觀察性實驗，藉此探討亞急性呼吸照護中心（respiratory care center，RCC）對長期依賴呼吸器病患實施呼吸器脫離計劃，此脫離計劃分三階段進行評估病患即階段一：呼吸器支持期、階段二：呼吸器脫離期、階段三：拔管期，比較實施呼吸器脫離計劃前（2015年01月到2016年12月）與實施後（2017年1月到2018年12月），在呼吸器使用天數、呼吸器脫離率、住院天數以及死亡率等影響，並分析影響呼吸器脫離成功和RCC呼吸器使用天數的因素。研究結果脫離計劃實施前（n = 161）、實施後（n = 124）兩組病患在RCC呼吸器天數（19.60 ± 9.16 vs. 21.52 ± 10.70）、RCC住院天數（22.81±8.43 vs.24.69 ± 9.55）、呼吸器脫離率（64％ vs. 69％）及死亡率（0.6％ vs. 0％）等，均沒有統計顯著性差異。單變量分析發現實施脫離計劃的呼吸器脫離成功的勝算比是未實施脫離計劃的1.227倍，是有比較高的脫離率，但無統計顯著性差異；而年齡、科別、意識分數、肺炎、腦部外傷、APACHE II score、轉入RCC氣道狀態、ICU呼吸器天數、ICU住院天數等與呼吸器脫離成功之間有顯著關係。故進行多變項羅吉斯迴歸分析發現年齡、科別、意識分數、APACHE II score、轉入RCC氣道狀態是增加脫離率的重要影響因素。結論：「實施呼吸器脫離計畫」對RCC病患在使用呼吸器天數、住院天數、呼吸器脫離率及死亡率均沒有得到顯著改善，而呼吸器脫離計劃之主導者、醫療照護團隊的輪替以及病患的年齡、科別、意識分數、APACHE II score及轉入RCC氣道狀態等，是影響「實施呼吸器脫離計畫」之效益結果之主要因素。

This is a retrospective study to explore the implementation of a ventilator weaning protocol for long term ventilator dependent patients in the respiratory care center. This protocol is assessing the patient in a three-step process, the first step: ventilator support phase, second step: ventilator weaning phase, the third step: extubation phase. Review medical charts of patients to compare the effects of the implement before (January 2015 to December 2016) and after (January 2017 to December 2018) the ventilator weaning protocol on ventilator days, weaning rates, hospitalization days, the mortality rate, and analyze the impact factors that influence the weaned off the ventilator successful. The results compared with before (n=161) and after (n=124) implement the ventilator weaning protocol on the ventilator days of RCC (19.6±9.16 vs. 21.52±10.70), hospitalization days of RCC (22.81±8.43 vs. 24.69±9.55), weaned off the ventilator successful (64% vs.69%) and mortality rate (0.6% vs. 0%), all the differences were not significant statistically. Univariate logistic regression analysis of the impact factors influence the weaned off the ventilator successful showed that weaning protocol group and not weaning protocol group the OR is 1.227, increase weaning rate but the differences were not significant statistically. The age, department, Glasgow Coma Scale, pneumonia, neurosurgery, APACHE IIscore, airway management, ventilator days of ICU, hospitalization days of ICU were significantly associated with the weaned off the ventilator successful. Multivariate logistic regression analysis revealed that age, department, Glasgow Coma Scale, APACHE IIscore and airway management were significant and independent factors associated with the increase weaning rate. Conclusions: ＂implementation of a ventilator weaning protocol＂ on ventilator days, hospitalization days, weaning rates and the mortality rate have not significant improvement. In this study, protocol-directed, rotation of health care team and patient's age, diagnosis, GCS, APACHE II scores and airway management are influential factors.

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