Outcomes of Patients after Discharge from the Respiratory Care Center

呼吸照護中心出院後患者之預後

黃明憲(Ming-Hsien Huang) ； 張漢煜(Han-Yu Chang) ； 顏麗卿(Li-Ching Yen) ； 林偉傑(Wei-Cheih Lin) ； 朱遠志(Yuan-Chih Chu) ； 陳炯睿(Chiung-Zuei Chen) ； 李政宏(Chang-Wen Chen) ； 陳昌文(Cheng-Hung Lee) ； 薛尊仁(Tzuen-Ren Hsiue)

《胸腔醫學》 21卷1期 (2006/02) Pp. 16-24

https://doi.org/10.29806/TM.200602.0003

摘要

背景：因為在醫院的呼吸器脫離訓練單位中，比較少注意到有關於病患的長期預後，我們試著評估在南台灣的一個大學醫學中心從呼吸照護中心出院的病患預後。
方法：前瞻性的數據收集從西元2001年12月到2004年12月，在3年的時间追蹤的那些呼吸照護中心出院的病患。這些數據包括年齡，性別，潛在疾病，呼吸器總使用天數，加護病房以及呼吸照護中心的停留天數和呼吸器使用天數，離院狀況及後續照顧單位。以醫院的病歷記錄和直接詢問病患和／或家庭成員的電話訪談追蹤調查。
結果：全部總共240位長期呼吸器依靠（≥21天）的病患進入呼吸照護中心，總住院死亡率是163%（39位病患），68位病志(28.3%)由於呼吸器脫離不成功，因此轉移到慢性呼吸照護中心，133位病患(55.4%)成功脫離呼吸器而離閉呼吸照護中心。早期呼吸器脫離（RCC停留14天內）的呼吸器脫離成功率26.7%，中期呼吸器脫離（RCC停留15-28天）33.3%，和晚期呼吸器脫離（RCC停留＞28天）16.7%，據統計晚期呼吸器脫離者其成功呼吸器脫離的比率較低。The Kaplan-Meier (KM)存活曲線估計如下：l個月，70%（95%的信賴區間[CI]，65%到75%)；3個月，58%（52%到66%)，6個月，54%（46%到62%)；l年，43%(36%到50%)；2年，35%（28%到43%）。比較呼吸器脫離失敗者KM存活曲線估計，它們在這兩組之間的結果方面相當不同。
結論：大約一半的病患可以在我們的呼吸照護中心成功的呼吸器脫離。呼吸器無法脫離而離開呼吸照護中心之患者比起呼吸器脫離而離開呼吸照護中心之患者有明顯較低之存活率。在成功呼吸器脫離者，早期脫離和晚期脫離並無影響長期存活率及呼吸器不使用率，所以我們仍應積極嘗試讓患者脫離呼吸器。

關鍵字

預後 ； 存活 ； 呼吸器脫離 ； 長期呼吸器依靠

並列摘要

Background: Since little attention has been given to the long-term outcomes of patients in hospital-based ventilator weaning units, we sought to evaluate the outcomes of patients discharged from the Respiratory Care Center (RCC) in a university medical center in southern Taiwan.
Methods: A prospective data collection was performed with the patients who were admitted to the RCC during a 3-year period, from December2001 to December 2004. These data included age, gender, underlying disease, total ventilator days, ICU and RCC stay days, ICU and RCC ventilator days, hospital discharge status, and disposition. Long-term outcomes after discharge from the RCC were ascertained using a review of hospital medical records and/or direct inquiry of patients and/or family members through telephone interviews.
Results: Totally, 240 prolonged mechanical ventilator-dependent (≥21 days) patients were admitted to the RCC during the study period. Sixty-eight patients (28.3%) were unsuccessfully weaned, and transferred to the RCW, and 133 patients (55.4%) were successfully weaned from the ventilator and left the RCC; the overall hospital mortality rate was 16.3% (39 patients). The weaning rates for the 3 periods of RCC stay were: early weaning (within 14 days) at a rate of 26. 7%, mid-term weaning (15-28 days) at a rate of 33.3%, and late weaning (＞28 days) at a rate of
16.7%. Those patients who stayed in the RCC for more than 28 days had a statistically significantly lower rate of successful weaning. The Kaplan-Meier (KM) survival curve estimates of 240 patients after discharge from the RCC were as follows: 1 month, 70% (95% confidence interval [CI], 65% to 75%); 3 months, 58% (52% to 66%), 6 months, 54% (46% to 62%); 1 year, 43% (36% to 50%); 2 years, 35% (28% to 43%). The KM survival estimates of the unsuccessfully weaned patients after discharge were performed, and there were significant differences in the outcomes of these 2 groups. Within the group of 133 successfully weaned patients, those who underwent early, mid-term, and late successful weaning did not differ in their outcomes, including survival rate and the ventilator-independent rate, after discharge from the RCC.
Conclusion: About half of the patients were successfully weaned at our RCC. Patients discharged from the RCC had poorer outcomes if they were ventilator-dependent. And, early or late ventilator weaning in the RCC did not have an impact on the long-term survival or ventilator-independence of the patients.

並列關鍵字

outcomes ； survival ； weaning ； prolonged mechanical ventilator-dependent