長期呼吸器使用病人在慢性呼吸照護病房的呼吸器脫離因子分析與預後評估

Weaning Assessment and Outcomes in Patients with Prolonged Mechanical Ventilation in Respiratory Care Ward

彭綏劭(Sui-Shao Peng) ； 惠群(Chun Hui)

《內科學誌》 31卷5期 (2020/10) Pp. 348-358

https://doi.org/10.6314/JIMT.202010_31(5).08

摘要

當醫學進步，許多病人在經歷急性呼吸衰竭之後，雖然能存活下來，但仍無法脫離呼吸器，當呼吸器需要連續使用21天以上時，則被稱作是長期使用呼吸器個案，這群病人多是年紀大，且同時有多種慢性器官功能障礙，需要將困難脫離呼吸器的原因克服，達到新的病理與生理平衡，才有機會脫離呼吸器，這些病人往往長期住院，需要下轉到專門訓練脫離呼吸器的照護機構。而本研究藉由回溯性的資料整理，去了解慢性呼吸照護病房中，困難脫離呼吸器相關的決定因子，以及計算每月快淺呼吸指數系列變化等方式，用來預測呼吸器能否成功脫離。本研究發現，年紀超過80歲患者，或住院中罹患呼吸器相關性肺炎或膿胸等併發症，或是由ICU直接下轉，是長期使用呼吸器患者無法成功脫離呼吸器的獨立因素，此外，從第三個月開始，快淺呼吸指數在成功脫離組和困難脫離組之間，可以見到有意義統計學上的差異，反映出病人的肺功能或是整體生理功能進步，這項指數隨時間的變化趨勢，更具預後判斷價值。

關鍵字

呼吸器依賴（Ventilator dependent） ； 呼吸器成功脫離（Successful weaning） ； 快淺呼吸指數（Rapid shallow breathing index） ； 慢性呼吸照護病房（Respiratory care ward）

並列摘要

Patients who continuously use mechanical ventilation for more than 21 days were considered as victims of prolonged mechanical ventilation with chronically critical illnesses. For successful weaning off ventilator, we have to solve all the causes of difficult weaning or try to compensate organ capacity and work of loading on cardiopulmonary system to a new patho-physiologic balance. In clinical practice, we used to check up patients' weaning index to predict the possibility of successful weaning off ventilator, which was often considered as a surrogate marker for respiratory functional recovery. The goal of this study is to review patients' clinical data, including demographics, ventilator settings, biochemistry data, etiologies of acute respiratory failure, precipitating factors associated with difficult weaning and complications happened during hospitalization. In addition, previous mechanical ventilation duration before admission and referral weaning unit were also reviewed for analysis. This study found patients with age more than 80, or a direct step-down from ICU or acquiring a complication of pneumonia or empyema thoracis during hospitalization were independent factors associated with the difficulty to wean off prolonged mechanical ventilation. Meanwhile, single rapid shallow breathing index measurements might not good enough to predict successful weaning off mechanical ventilation, and trends of index measured monthly after admission to respiratory care ward showed the differences between successful weaning and ventilator dependent status.