- 期刊
內科重症病人能量代謝、呼吸參數與呼吸器脫離預後之相關性探討
Relationship between Weaning Profiles and Metabolic Status in patients in Medical Intensive Care Unit
摘要
背景與目的：重症病人呼吸器脫離時，常因呼吸做功增加、呼吸肌疲勞、營養不良等因素脫離失敗。患者呼吸作功負荷增加，可能造成能量消耗的增加。間接熱量測量儀監測患者的能量消耗狀態。本回溯型研究目的為分析內科重症病人的呼吸器脫離參數與能量代謝參數之相關性，以及對於呼吸器脫離預後之影響。研究方法：本研究為回溯性研究，以2020/08-2022/03間，入住某醫學中心內科加護病房的病人為對象，資料來源為醫院資料庫，使用自製抄錄表進行資料收集。收集患者以間接熱量測定法（Indirect calorimetry, IC）蒐集到的耗氧量、二氧化碳產生量、能量消耗等數據，呼吸器脫離參數如潮氣容積、每分鐘通氣量、最大吸氣壓、快淺呼吸指數。病人呼吸器脫離結果也列入分析。結果：共50人完成資料收集。呼吸器脫離成功率為88%。呼吸器脫離成功組快淺呼吸指數（53.9±26.1）顯著低於失敗組（85.0±25.4）（p=0.009）。相關分析發現，病人每分鐘通氣量與能量消耗成正比（r=0.480, p=0.001）。最大吸氣壓與能量消耗（r=0.2594, p=0.042）、二氧化碳產生量（r=0.315, p=0.029）成正比。呼吸器病人呼吸肌力較大者，伴隨有較高的能量消耗。結論：重症病人呼吸肌力、每分鐘通氣量較高者，伴隨有較高的二氧化碳產生量及能量消耗。照護呼吸器病人時，間接熱量測量儀或可做為評估呼吸做功與呼吸脫離訓練的依據。
並列摘要
Background: Critical illness patients with critical illness are often failed to wean from mechanical ventilation due to workload of breathing (WOB), respiratory muscle fatigue, malnutrition and/or other factors. The increased workload of breathing can lead to high energy expenditures. Indirect calorimetry monitors energy expenditure status non-invasively. The purpose of this retrospective study was to analyze the relationship between weaning parameters and metabolism status in critically ill patients Methods: This was a retrospective study. Patients admitted to medical intensive care units during August 2020 and March 2022 were recruited as subject. The data were collected from the hospital secondary database using a self-made data collection form. The collection data included the indirect calorimetry measurement such as t oxygen consumption, carbon dioxide production, and energy expenditure. The Ventilator weaning parameters such as tidal volume, minute ventilation, maximal inspiratory pressure, and rapid shallow breathing index were also collected Results: The ventilator weaning successfully rate was 88%. In the group that successfully weaned from the ventilator, the rapid shallow breathing index (53.9±26.1) was significantly lower compared to the failure group (85.0±25.4) (p=0.009). Correlation analysis revealed that the patient's minute ventilation was positively correlated with energy expenditure (r=0.480, p=0.001). The maximal inspiratory pressure was also positively correlated with energy expenditure (r=0.2594, p=0.042), as well as with carbon dioxide elimination (r=0.315, p=0.029). Patients with greater respiratory muscle strength were associated with higher energy expenditure. Conclusion: Patients with higher respiratory muscle strength and minute volume were accompanied by higher carbon dioxide elimination and energy expenditure. The monitor of metabolic status may provide information for accurately predicting weaning outcomes in critical illness patients.