The Effect of Self-extubation on the Outcome of Mechanical Ventilation

自拔氣管內管對使用呼吸器病人預後的影響

陳宗成(Tzong-Cherng Chen) ； 金湘玲(Shiang-Ling King) ； 王家弘(Jhi-Horng Wang)

《胸腔醫學》 20卷6期 (2005/12) Pp. 548-554

https://doi.org/10.29806/TM.200512.0006

摘要

前言：未經計劃的氣管內管拔除已經被証明有許多不良的併發症。我們在呼吸治療加護病房，觀察自拔氣管內管對病人預後的影響。
方法：我們回溯分析台北榮民總醫院2001年一月至2003年十二月，呼吸治療加護病房中，接受氣管內管及呼吸器治療大於12小時且發生自拔氣管內管病患。每個案例依據年齡、性別、呼吸衰竭的原因、APACH II的分數及住院時間，找出兩個對照病患。基於減低護理人員照顧品質的影響，我們排除意外氣管內管拔除的案例。
結果：發生未經計劃的氣管內管拔除共有一百零五位病患(15.5%)，我們排除其中屬於意外性氣管內管拔除的九位病患。三十五位病患(45.5%)在自拔氣管內管72小時內需要再次插管。自拔氣管內管的病患在呼吸治療加護病房住院時間比較長(p=0.03)，但是在依賴呼吸器的時間、住院時間、死亡率、慢性照護需求，與未發生自拔氣管內管的病患並無差異。自拔氣管內管失敗的病患比成功的病患，需要較長的呼吸器支持時間、住院時間及呼吸治療加護病房住院時間，死亡率較高，也比較需要氣切手術及長期依賴呼吸器。自拔氣管內管成功可減短呼吸器支持的時間及呼吸治療加護病房住院的時間，不過在其它預後方面並無明顯的助益。
結論，此次回溯研究發現自拔氣管內管只導致加護病房住院時間延長。自拔氣管內管失敗代表病患的預後較差。相對地，成功自拔氣管內管可減短呼吸器支持時間及加護病房住院時間，不過在其它預後方面並無明顯的差異。

關鍵字

未經計劃的氣管內管拔除 ； 自拔氣管內管 ； 意外氣管內管拔除 ； 預後

並列摘要

Background: Unplanned extubation (UE) is a recognized complication of translaryngeal intubation and several adverse effects on outcome have been demonstrated. In this study, we sought to investigate the effect of self-extubation (SE) on the outcome of mechanical ventilation in our Respiratory Therapy Care Unit (RTCU).
Methods: A retrospective, case-controlled study of patients who were admitted to the RTCU of Taipei Veterans General Hospital over a period of 3 years (January 2001 to December 2003). Patients who required more than 12 hours of mechanical ventilation with an endotracheal tube (ETT) were included in this study. Two control subjects in the same RTCU who had not selfextubated were matched to each case based on age, gender, indication for mechanical ventilation, Acute Physiology and Chronic Health Evaluation II score (APACHE II) and time hospitalized (within the same quarter). We excluded accidental-extubation (AE) events from this study to reduce the effect of the nursing staff.
Results: UE occurred in 105 patients (15.5%). AE occurred in 9 patients (8.6%) and they were excluded from the study. Thirty-five patients (45.5%) required reintubation within 72 hours of SE. Compared to the control groups, those who self-extubated had a longer length of RTCU stay (19.7 vs 25.7 d, p=0.03), but had no difference in the duration of MV and hospital stay, mortality rate, and the need for chronic care. Patients who failed SE had a longer duration of MV, length of RTCU and hospital stay, a higher rate of mortality, ventilatory dependence and the need of a tracheostomy as compared to those who tolerated SE. Successful SE reduced the duration of MV and the length of RTCU stay, but had no other obviously beneficial effect on outcome as compared with the control group.
Conclusions: In this retrospective study, SE only resulted in a prolonged duration of ICU stay. Failed SE represented poor outcomes. In contrast, successful SE reduced the duration of MV and the length of ICU stay, but had no other beneficial effect on outcomes.

並列關鍵字

unplanned extubation ； self-extubation ； accidental extubation ； outcome