運動訓練措施對病人脫離呼吸器之成效分析

Performance Analysis of Exercise Training Program for Ventilator-carried Patients Weaning From Respirator

陳美娟(Chen, Mei-Chuan) ； 童惠芳(Tung, Hui-Fang) ； 林柏瑤(Lin, Po-Yao) ； 陳玉萍(Chen, Yu-Ping) ； 白玉珠(Pai, Yu-Chu)

《健康與建築雜誌》 4卷1期 (2017/02) Pp. 60-66

https://doi.org/10.6299/JHA.2017.4.1.R7.60

摘要

背景：病人使用呼吸器天數與死亡率密切相關，適時適當的運動訓練介入措施，儘早協助病人脫離呼吸器相當的重要。目的：本研究目的為運動訓練對病人脫離呼吸器之成效分析。方法：以病歷回溯調查法隨機抽樣，收集2 年某醫學中心加護中心使用呼吸器病人之病歷資料。研究工具為病人基本資料及脫離呼吸器評值量表，依病歷之醫囑分出有運動及無訓練各179 份之病歷資料共358 份。結果：研究結果脫離呼吸器成功率訓練組(90%)顯著高於無訓練組病人(78.2%)（t =3.07, p = .002），脫離呼吸器評估量表得分亦達顯著差異（44.07± 4.91 vs 41.21±5.81 ; t =5.03, p = .000），住加護中心天數(19.06±12.70 vs 23.35±17.77 ; t =-2.63, p = .009）及使用呼吸器天數（13.28±11.80 vs18.17±17.22; t =-3.13, p = .002）亦均達顯著差異；進行邏吉式迴歸分析，成功脫離呼吸器之預測因子為性別(OR .430 )、尿素氮(OR .871)、呼吸快淺指標(OR .915)、使用呼吸器天數(OR .886)及住加護中心天數(OR .812)為影響脫離呼吸器成功之預測因子，可解釋總變異量為28.9%。結論與應用：因此積極協助病人執行運動訓練，將促使提升脫離呼吸器成功率，降低加護中心天數，節省醫療健保費用及社會成本。

關鍵字

呼吸器 ； 脫離 ； 運動訓練

並列摘要

Background: Mortality rate is proportional to the carried days of patients with mechanical ventilator. It is important to apply an appropriate intervention timely for assisting patients weaning ventilators early. Purposes: The purpose of this study was to analyze the efficacy of exercise training program for patients with ventilators. Methods: A retrospective study was utilized. Subjects were recruited from intensive care units of a medical center in northern Taiwan. Medical charts of 2 years were reviewed to collect data related to ventilator-carried history. ＂Weaning ventilator scale＂ was used as a study instrument. Results: Medical Charts of 358 patients were collected in this study; they were divided into experimental (179) and control groups (179) according to their medical records. Weaning rate (90% vs 78.2%; t =3.07, p = .002),weaning ventilator scale(44.07± 4.91 vs 41.21 ± 5.81; t =5.03, p = .000), length of ICU stay(19.06±12.70 vs 23.35±17.77; t = -2.63, p = .009)and ventilator day(13.28±11.80 vs 18.17±17.22; t =-3.13, p = .002)were significantly different between the experimental and control groups. In logistic regression analysis, the predictors of weaning ventilator were gender (OR .430), BUN(OR .871), RSI (OR .915), ventilator day(OR .886), and length of ICU stay(OR .812). The total variance can be explained by the final regression equation 28.9%. Conclusions: Implementing the exercise training program for weaning ventilators in respirator-carried patients could significantly enhance weaning rate, reduce length of ICU stay days, and save medical and social cost.

並列關鍵字

ventilator ； weaning ； exercise training