呼吸器依賴病人呼吸器脫離結果之相關因素探討

長期使用呼吸器會導致許多合併症的產生，對病人及家屬不僅帶來身心靈性等層面的痛苦，更會嚴重影響生活品質與增加經濟負擔，因此，協助呼吸器依賴病人早日脫離呼吸器，是醫療人員很重要的任務與工作目標。本研究的目的在探討呼吸器依賴病人呼吸器脫離結果之相關因素，採描述性相關性研究設計，以26 項「呼吸器脫離評估項目表」進行病歷回溯，共收集及分析180位呼吸器依賴病人的病歷資料。研究結果顯示，呼吸器脫離評估項目表之得分百分率≧67%可預測呼吸器脫離成功，其敏感性88%、特異性79%、陽性預測值77%、陰性預測值89%及準確率83%、陽性相似比值4.1、陰性相似比值0.15。呼吸器脫離評估項目表中各項目，「每分鐘通氣量」、「淺快呼吸指數＜105次/min/L」、「有無氣切」、及「CXR正常或改善情形」，等四項為呼吸器脫離成功決定因子，此外。研究結果顯示四項因子直接預測呼吸器脫離結果，切割點為≧ 3分，其敏感性為 91 %、特異性為 88 %、陽性預測值為 77 %、陰性預測值 92 % 及準確率為89 %、陽性相似比值 7.58、陰性相似比值 0.10。本研究發現呼吸器脫離評估項目表能有效預測呼吸器的脫離結果，研究結果建議臨床應發展呼吸器脫離評估指引，提供醫護人員在進行呼吸器脫離前對病人的整體性評估，降低病人嘗試脫離失敗的機會，除能減少人力、時間之耗費，更提高醫療品質，減少醫療成本之支出。

關鍵字

呼吸衰竭；呼吸器依賴；呼吸器脫離評估；呼吸器脫離結果

並列摘要

Long-term use of ventilators would result in several complications, which not only cause physical, psychological and spiritual suffering but also affect quality of life and increase financial burden in patients and their families. Therefore, assisting ventilator-dependent patients in early weaning from ventilators has become an important task and objective for medical professionals in the respiratory care center (RCC). The purpose of this study was to explore the related factors of ventilator weaning outcome in ventilator-dependent patients. A descriptive, correlational research design was employed. Retrospective data was collected from the patients’ medical charts using a 26-item “ventilator weaning assessment checklist.” A total of 180 medical charts was reviewed and analyzed. The study results showed that a score of ?d 67% to the ventilator weaning assessment checklist could predict successful weaning. The sensitivity was 88% and specificity was 79%, with positive and negative predictive values of 77% and 89%, respectively, accuracy of 83%, and positive and negative likelihood ratios of 4.1 and 0.15, respectively. Among all the factors in the checklist, four determinant factors of successful weaning were identified as follows: “minute ventilation,” “rapid shallow breathing index ?? 105 breaths/min/L,” “with or without tracheostomy,” and “chest x-ray normal or improving.” In addition, we found that these four factors could directly predict the ventilator weaning outcome. At a cutoff ?d 3, the sensitivity was 91% and specificity was 88%, with positive and negative predictive values of 77% and 92%, respectively, accuracy of 89%, and positive and negative likelihood ratios of 7.58 and 0.10, respectively. This study found that the ventilator weaning assessment checklist could effectively predict the ventilator weaning outcome. Findings of this study suggest that a clinical assessment guideline for ventilator weaning should be developed to provide medical professionals with ability to conduct a holistic assessment of patients before weaning and to reduce the chances of failed weaning attempts, thereby not only saving manpower and time consumption but also improving healthcare quality and reducing medical costs.