- 期刊
呼吸照護中心實施呼吸器脫離計劃之效益評估
Evaluation of the Effects of the Ventilator Weaning Protocol in the Respiratory Care Center
摘要
目的：探討實施呼吸器脫離計劃，對呼吸器使用天數、呼吸器脫離率、加護病房住院天數及醫療費用的影響。 方法：以回溯性病歷調閱之研究方法，比較某醫學中心呼吸照護中心(respiratroy care center, RCC)實施呼吸器脫離計劃前(2001年8月到10月)與實施後(2001年12月到2002年2月)，呼吸器使用天數，加護病房住院天數，呼吸器脫離率及醫療費用的影響。 結果：實施呼吸器脫離計劃後，住RCC期間呼吸器使用天數平均下降3.6天(15.3±11.2 vs. 18.9±14.1; p=0.332)，住院天數平均可下降3.2天(17.5±10.7 vs. 20.7±12.9; p=0.319)；呼吸器脫離成功率較實施前略為上升(64% vs. 59%, p=0.665)；醫療費用每人平均可節省8.4%(12,198元)，但均未達明顯統計意義。但完成呼吸器脫離計劃的病患比中斷執行者其呼吸器脫離率較高，且有明顯統計差異(42.1% vs. 73%, p=0.024)。進入RCC前的加護病房住院天數(23.2±10.0 vs. 26.0±7.4; p=0.029)、使用呼吸器之天數(20.8±7.6 vs. 25.1±7.3; p=0.005)、總住院天數(56.2±18.1 vs. 63.6±15.5; p=0.038)及呼吸器總天數(36.1±13.9 vs. 44.0±16.6; p=0.049)均下降。 結論：在RCC實施呼吸器脫離計劃，對呼吸器使用天數、呼吸器脫離率、住院天數及節省醫療費用雖有所助益，但未達明顯統計差異，需更大型的研究方能確定其效果。
並列摘要
Objective: To evaluate the effects of the ventilator weaning protocol on ventilator days, weaning rates, ICU days and hospital costs. Methods: The retrospective study done by the respiratory care center of the medical center reviewing medical charts to compare the effects of the implement before (August 2001 to October 2001) and after (December 2001 to February 2002) the ventilator weaning protocol on ventilator days, ICU days, weaning rates and hospital costs. Results: The ventilator days and hospitalization days in the RCC reduced averagely accordingly: 3.6 days (15.3±11.2 vs. 18.9±14.1; p=0.332) and 3.2 days (17.5±10.7 vs. 20.7±12.9; p=0.319). The successful weaning rate slightly increased (64% vs. 59%; p=0.665) after the implement; the average hospital cost savings per person were 12198 NTD (8.4%); all the differences were not significant statistically. The weaning rate was significantly higher in patients who accomplished weaning protocol (73% vs. 42.1%; p=0.024). Protocol-guided weaning decreased hospitalization days (23.2±10.0 vs. 26.0±7.4; p= 0.029) and ventilator days (20.8±7.6 vs. 25.1±7.3; p=0.005) in the ICU (before the RCC admissions), and the totality of both hospitalization days (56.2±18.1 vs. 63.6±15.5; p=0.038) and ventilator days (3 6.1±13.9 vs. 44.0±16.6; p=0.049) in the hospital. Conclusion: Implementation of the ventilator weaning protocol in the respiratory care center can be conducive to ventilator days, weaning rates and hospital cost savings but the significances require further large scale prospectively random study.