Determining Factors for Successful Weaning of Patients in a Respiratory Care Center-A One-Year Experience

轉人呼吸照護中心病人呼吸器脫離成功之決定因子

陳長宏(Chang-Hung Chen) ； 林偉傑(Wei-Chieh Lin) ； 李政宏(Cheng-Hung Lee) ； 陳烔睿(Chiung-Zuei Chen) ； 朱遠志(Yuan-Chih Chu) ； 張漢煜(Hang-Yu Chang) ； 薛尊仁(Tzuen-Ren Hsiue)

《胸腔醫學》 19卷4期 (2004/08) Pp. 236-242

https://doi.org/10.29806/TM.200408.0001

摘要

鑒於長期呼吸器依賴病人的增多，本院於民國九十年十二月成立呼吸照護中心，專收呼吸器長期依賴及難以脫離之病患。本研究之目的在探討呼吸照護中心內病人之特性及呼吸器脫離成功之決定因子。本研究由民國九十年十二月起至九十一年十二月止，一年間共收集了95個呼吸器長期依賴病人的各項變項。本研究顯示，病患中男性病人佔53%，平均年齡71.2+l4.5歲，病患轉入RCC後，成功呼吸器脫離比率為59/95(62%)（呼吸器脫離後時間大於72小時），在成功脫離呼吸器的病人中，有55個病人(93%)在前21天脫離，只有2個病人脫離時間大於30天。有22個病人死亡(23%)。病人的疾病分類中肺炎和慢性阻塞性肺疾病佔45%，外科病人佔24%，心臟衰竭佔6%，感染症和敗血症佔13%，癌症病人佔7%，腦血管意外佔3%。主要呼吸器脫離訓練模式(75%)為壓力支持模式(Pressure Support)。有87%的病人接受氣管造口手術。經由統計分析，呼吸器脫離成功之決定因子為病人住進加護病房時的APACHE Ⅱ分數，住進RCC時血漿白蛋白數值(Albumin)，及病人住進 RCC 時動脈血氧氣分壓和吸入氧氣濃度之比率(PaO2/FiO2)。設立RCC後，本院內科加護病房平均住院日由12.2日降為9.7日。本研究顯示RCC的設立提高了呼吸器的脫離成功率，也增加了加護病房的使用率，病人有較低的APACHE Ⅱ分數，較高的血漿白蛋白值以及較高的 PaO2/FiO2比率，有較高的機會成功脫離呼吸器。

關鍵字

呼吸照護中心 ； APACHE Ⅱ分數 ； 血漿白蛋白數值 ； 動脈血氧氣分壓和吸入氧氣濃度之比率

並列摘要

Many serious medical illnesses require intensive care and mechanical support. Patients ventilated for a prolonged period (ventilator period＞21 days) often consume a large amount of intensive care resources. The Respiratory Care Center (RCC), with a 10-bed capacity, was set up in our hospital in December 2001. In this retrospective study, we explore the characteristics of the long-term ventilator-dependent patients in our hospital, and attempt to discover the determining factors in successful weaning and their impact on intensive care unit (ICU) operations.
Ninety-five patients with prolonged mechanical ventilation (53% male; age: 71.2+14.5 years) were transferred to the RCC between December 2001 and December 2002. The patients' disease categories included pneumonia in 32% of cases, COPD in 6%, CHF in 6%, cardiovascular operation in 13%, neurological operation in 7%, sepsis in 13%, stroke in 3%, and cancer in 7% of cases. The average length of RCC stay was 19 days (mean + SD 19.04 + 13.8). Sixty-three patients (66%) were discharged from the RCC in the first 21 days. Fifty-nine patients (62%) were successfully weaned from the ventilator (discontinued ventilator (after more than?) ＞72 hours). Fifty-five patients (93% of all weaned patients) were weaned in the first 21 days. Only 2 patients were weaned after 30 days. Twenty-two patients expired and the mortality was 23%. The major weaning method was pressure support (75%). The determining factors for a successful weaning were: APACHE II score at ICU admission (19.29 + 3.48 vs 25.56 + 5.93, p 0.0001), P(subscript a)02/FiO2 at RCC admission (mmHg) (296.53 + 83.39 vs 232 + 103.55, p=0.001), and albumin level at RCC admission (mg/dl) (2.74 + 0.42 vs 2.4 + 0.4, p=0.0001). The impact on our Medical and Respiratory ICU before and after the set-up of the RCC was a decrease in hospitalization (12.2 vs 9.7 days, under 99% of beds occupied, p＜0.05).

並列關鍵字

respiratory care center (RCC) ； APACHE Ⅱ score ； albumin ； PaO2/FiO2