Home Mechanical Ventilation in Central Taiwan: Experiences at China Medical College Hospital

慢性呼吸衰竭病患居家使用呼吸器：中國醫藥學院附設醫院的經驗

夏德椿(Te-Chun Hsia) ； 杭良文(Liang-Wen Hang) ； 王德源(Der-Yuan Wang) ； 顏至慶(Chih-Chihng Yen) ； 楊篿(Shwen Yang)

《Mid-Taiwan Journal of Medicine》 5卷4期 (2000/12) Pp. 248-255

https://doi.org/10.6558/MTJM.2001.5(4).7

摘要

目的 探討慢性呼吸衰竭病患居家使用呼吸器其診斷、效益、死亡原因及合併症等結果。方法我們回顧分析從1991至1998年所有曾在本院接受治療並在家中使用呼吸器的病患。存活時間由出院開始計算至病患死亡或撤機成功止。死亡率、併發症以及訓練使用居家呼吸器的時間亦列入探討。呼吸照護使用的消耗品耗費之金額計算，我們是抽出5位病患為代表平均。護理照護的費用亦列入花費統計。藥物的使用，因病人疾病狀況不同，故不列入花費統計。
結果 病患中有18 位(佔58%)為神經肌肉疾病(包括中樞神體病症)，4例為脊髓損傷，3位病患使用非侵犯型雙向正壓呼吸器，2位使用負壓呼吸器。在這單位病患中，有4位病患成功脫離呼吸器，有11位病人(佔36%)在家中或醫院因呼吸器管時脫離或併發其他會併症而死亡。成人的死亡率大於小孩。大多數這些需要依輔照顧並使用呼吸器的病患，在家中照顧所需的花費少於在醫院所需的花費。
結論 由以上結果我們建議一些生命徵候穩定，但需要長期使用侵犯型呼吸器或非侵犯型呼吸器的病人，可以選擇居家安養。

關鍵字

花費 ； 慢性呼吸衰竭 ； 併發症 ； 診斷 ； 居家照護 ； 呼吸器

並列摘要

Objective. To ascertain the outcome, benefits, and complications of patients using home care ventilation.
Methods. We reviewed the hospital charts and clinical records of all patients who had been admitted to our hospital and used a mechanical ventilator at home from 1991 through 1998. The starting point for data collection on survival was the date of discharge from the hospital. The end point was either the patient's death or the time when support using a mechanical ventilator was discontinued. The mortality rate was calculated. The cost data for the different types of ventilators were obtained from two local vendors. The cost of disposable respiratory care items (suction catheters; sterile water) was obtained by averaging the expenses from five patients. Nursing charges were surveyed for our community. Medications varied widely among patients and were not included in the estimated costs of care using a ventilator at home.
Results. Twenty-six adult and five children with chronic respiratory failure are enrolled; 18 (58%) of them had neuromuscular diseases (including central nervous system disorders), and four had injuries to the spinal cord. Three of the patients used non-invasive bi-level positive pressure ventilators and two used negative pressure ventilators. Among the 31 patients, four were eventually weaned from the ventilator, and 11 (36%) died at home or in the hospital due to disconnection from the ventilator other complications. The mortality rate was greater for adults than for children. For the majority of the patients, the cost of management at home was significantly less than the cost of management in the hospital, depending largely on the level of nursing care required.
Conclusions. We suggest that mechanical ventilation at home is a reasonable alternative to prolonged hospitalization on for medically stable ventilator-dependent patients, and non-invasivemechanical ventilation may be useful for some patients. ”

並列關鍵字

benefit ； chronic ventilator ； complications ； diagnosis ； home care ； mechanical