APACHE Score Used in Predicting Weaning Outcomes in an Intermediate Respiratory Care Center

APACHE分數系統用來預測呼吸照護中心病患預後

吳沼漧(Chao-Chien Wu) ； 張谷州(Ku-Chou Chang) ； 黃裕靜(Yu-Ching Huang) ； 沈連喜(Lien-Shi Shen) ； 高旭卿(Hsu-Ching Kao) ； 王逸熙(Yi-Hsi Wang) ； 劉世豐(Shih-Feng Liu) ； 王金洲(Chin-Chou Wang) ； 林孟志(Meng-Chih Lin)

《胸腔醫學》 30卷5期 (2015/10) Pp. 271-279

摘要

前言：本研究探討呼吸照護中心（RCC）長期使用機械通氣的病患，分析其結果與急性生理和慢性健康評估（APACHE）II的相關性。方法：這是一個前瞻性的觀察研究，在呼吸照護中心連續收錄長期使用機械通氣的病患。分析記錄其人口統計學、轉入來源、脫離呼吸器的時間、脫離呼吸器的結果及在24小時內抵達呼吸照護中心所測的APACHE Ⅱ評分。脫離呼吸器的結果分為四組，成功脫離、死亡、重返重症加護病房、下轉到呼吸照護病房。結果：我們篩選了6820位呼吸機使用患者，其中508例患者被收入本案。進入呼吸照護中心之前使用機械通氣的平均時間為31.1±18.6天，平均APACHE Ⅱ評分為19.3±6.2，停留在呼吸照護中心的平均時間為21.3±13.4天。脫離呼吸器的結果是55.5%成功脫離，20.3%沒有脫離且下轉到呼吸照護病房，19.7%死亡，4.5%重返重症加護病房。在呼吸照護中心，10天內死亡率為4.9%，10天內成功脫離率為40%。APACHE Ⅱ評分與成功脫離呈負相關，APACHE Ⅱ評分與死亡率呈正相關，但與停留在呼吸照護中心的時間沒有相關。結論：APACHE Ⅱ評分在預測呼吸照護中心患者的預後是中度可靠的。我們的研究結果在改革服務長期使用機械通氣的病患上，提供有價值的信息。

關鍵字

呼吸器脫離 ； 中級照護機構 ； 呼吸照護病房 ； 長期照護

並列摘要

Background: This study explores the outcomes of patients with prolonged mechanical ventilation (PMV) treated in an intermediate respiratory care center (RCC), and assesses the effectiveness of the Acute Physiology and Chronic Health Evaluation (APACHE) II scoring system in predicting outcomes in this group of difficult-to-wean patients. Methods: A prospective observational study was used to recruit consecutive PMV patients in an RCC. Demographics, patient source, time to weaning, and outcomes of weaning attempts were recorded. The APACHE II score was obtained within 24 hours after arriving at the RCC. Outcomes measured were successful weaning, mortality, transfer back to the intensive care unit, and transfer to the respiratory care ward. Results: In all, 508 consecutive patients from among the 6820 ventilator patients screened were recruited. The mean duration of mechanical ventilation before entering the RCC was 31.1±18. 6 days. The mean APACHE II score was 19.3±6.2 on arrival at the RCC. The mean duration of RCC stay was 21.3±13.4 days. Of the recruited patients, 55.5% were successfully weaned, 20.3% failed to wean, 19.7% died, and 4.5% were transferred back to intensive care units; 40% of the successfully weaned patients were weaned by day 10. The APACHE II score was negatively correlated with successful weaning, and positively correlated with mortality, but bore no relationship with the duration of RCC stay. Conclusion: The APACHE II score is moderately reliable in predicting outcomes of patients in an RCC. Our results offered some information that could be used in reforming services for PMV patients.

並列關鍵字

ventilator weaning ； APACHE ； intermediate care facilities ； respiratory care center ； long-term care