長期使用呼吸器病人死亡風險因素探討－以亞急性呼吸照護病房為例

Explore the risk factors of mortality in patients requiring prolong mechanical ventilation: An example of a subacute respiratory care center

10.6269/JRT.202407_23(2).0002

林育秀(Yu-Hsiu Lin)；蕭琇憶(Hsiu-Yi Hsiao)；楊聰明(Tsung-Ming Yang)；方瑱珮(Tien-Pei Fang)；洪明賜(Ming-Szu Hung)

長期使用呼吸器 ； 死亡因素 ； 亞急性呼吸照護病房 ； prolong mechanical ventilation ； risk factors of mortality ； subacute respiratory care center

呼吸治療

23卷2期（2024 / 07 / 01）

15 - 30

繁體中文;英文

背景與目的：隨著使用呼吸器時間越久，脫離呼吸器的機率越低，需長期使用呼吸器，致使醫療照護耗時甚久，死亡率隨之增加，本研究目的為探討影響長期使用呼吸器病人死亡之相關因素，以輔助醫療決策並及早介入適當處置。研究方法：以2009-2019年間，入住某區域醫院亞急性呼吸照護病房（respiratory care center, RCC）之病人為研究對象，並排除重複入住之病人，共1,649人。採用SAS 9.4分別進行描述性、雙變項及Cox迴歸分析，探討長期使用呼吸器病人死亡風險之重要獨立相關因子。結果：研究結果顯示，急性腎損傷（HR=1.323, p=0.012）、需要在RCC執行血液透析（HR=0.720, p=0.014）、肺部癌症為活動性，仍治療中（HR=1.978, p<0.0001）、其他癌症為活動性，仍治療中（HR=1.886, p<0.0001）、急性生理和慢性健康評分（HR=1.045, p<0.0001）、血小板過低（HR=1.405, p=0.001）、白蛋白過低（HR=2.236, p=0.020）、氣道介面，為氣管內管（HR=1.701, p=0.0008）、使用呼吸器原因，為慢性肺損傷（HR=0.516, p=0.014）與病人死亡因素獨立相關。結論：藉由本研究分析結果，更確立與PMV病人死亡之重要因素，期改善臨床醫療品質，亦提供並輔助日後醫療團隊執行治療處置參考方向。

Background: Prolonged mechanical ventilation (PMV) leads to an extended period of medical care and is associated with increased mortality rate. The purpose of this study is to explore the risk factors of mortality in PMV patients. Methods: PMV patients' information were restricted from the electronic medical records and medical information system databases in a subacute respiratory care center (RCC) of a regional teaching hospital in District from 2009 to 2019. A total of 1,649 patients were included in this study. SAS 9.4 applied to analyze descriptive statistics, bivariate analysis and cox regression to explore the factors related to death in PMV patients. Results: The results found that in the multivariate logistic regression, the following variables were significant associated to PMV patients' death, including AKI(HR=1.323, p=0.012), need dialysis at RCC(HR=0.720, p=0.014), lung cancer of active(HR=1.978, p<0.0001), other cancer of active(HR=1.886, p<0.0001), APACHE II score(HR=1.045, p<0.0001), Platelet too low(HR=1.405, p=0.001), P(HR=1.369, p=0.016), Albumin too low(HR=2.236, p=0.020), airway interface for endotracheal tube (HR=1.701, p=0.0008),etiology of mechanical ventilation from chronic lung injury(HR=0.516, p=0.014).Conclusions: When the relevant clinical records changes in patients, medical team member could provide a real time of intervention. It could also improve the quality of clinical medical treatment and provide and assist the medical team to carry out treatment and treatment in the future.