Predictors of Sleep Quality and Successful Weaning From Mechanical Ventilation among Patients in Respiratory Care Centers

呼吸照護中心病患睡眠品質及成功脫離呼吸器之預測因素

陳靜如(Ching-Ju Chen) ； 許玲女(Ling-Nu Hsu) ； Gretl McHugh ； Malcolm Campbell ； 曾雅玲(Ya-Ling Tzeng)

《The Journal of Nursing Research》 23卷1期 (2015/03) Pp. 65-74

https://doi.org/10.1097/jnr.0000000000000066

摘要

背景　睡眠品質不佳可能導致呼吸肌無法放鬆而影響呼吸器成功脫離。然而少有研究探討影響呼吸器脫離病患的睡眠品質與呼吸器脫離結果的關係。目的　本研究旨在探討影響呼吸器脫離病患睡眠品質與成功脫離呼吸器之預測因素。方法　採橫斷面研究設計。以結構式問卷收集中部某醫學中心呼吸照護單位94位執行呼吸器脫離訓練的病患資料。問卷內容包括人口學和健康狀況、疾病嚴重度分類系統量表、意識清醒程度評量表、以及維辛式睡眠量表。採逐步複迴歸和羅吉斯迴歸進行多變量分析。結果　呼吸器脫離成功率為56.4%（n=53）。與未脫離呼吸器的病患比較，脫離病患年齡較輕（p=.038）、病情嚴重度較低（p＜.001）、以及有較好的睡眠品質（p=.004）。睡眠總分之預測因子為疾病嚴重度（B=-1.32）、目前有使用安眠藥（B=-10.71）、以及3-4種慢性病（B=-9.91）。呼吸器脫離成功的預測因子為意識程度（OR=1.64）、睡眠品質（OR=1.05）、疾病嚴重度（OR=0.81）、以及飲酒史（OR=0.21）。結論／實務應用　本研究顯示，疾病嚴重度、睡眠品質影響呼吸器脫離。增進對這些危險因素的瞭解，有助於護理人員和臨床專業照護者提昇呼吸器脫離過程病患之照護品質。

關鍵字

睡眠品質 ； 脫離 ； 呼吸器 ； 呼吸照護中心

並列摘要

Background: Poor quality of sleep may result in more problems for patients who undergo weaning from mechanical ventilation because it could result in disabled muscle relaxation and affect the function of the respiratory muscles. Few studies have specifically investigated what factors contributed to quality of sleep and weaning outcomes. Purpose: This study investigates the predictors of quality of sleep and successful weaning from mechanical ventilation in patients at respiratory care centers. Methods: We used a cross-sectional design to recruit 94 patients who were in the process of weaning from ventilation at three respiratory care centers in a medical center in central Taiwan. A structured questionnaire was used to collect data. Disease severity during the first 24 hours after commencing the weaning process was assessed using the Acute Physiology and Chronic Health Evaluation II. Level of consciousness was evaluated using the Glasgow Coma Scale, and quality of sleep was measured using the Verran and Snyder-Halpern Sleep Scale. Stepwise multiple regression and logistic regression were used for multivariate analysis. Results: Fifty-three (56.4%) of the 94 participants successfully completed the weaning process. Participants who successfully weaned within 72 hours were younger (p=.038), had a lower level of disease severity (p﹤.001), and had a better quality of sleep (p=.004) than their counterparts who failed to wean. Factors including disease severity (B=-1.32), current use of hypnotic drugs (B=-10.71), and having three-to-four coexisting chronic diseases (B=-9.91) contributed negatively to quality of sleep. Factors including level of consciousness (odds ratio [OR]=1.64), quality of sleep (OR=1.05), disease severity (OR=0.81), and alcohol consumption history (OR=0.21) were found to significantly impact weaning success. Conclusions/Implications for Practice: A strong relationship was identified between disease severity and quality of sleep. Both factors are significant predictors of successful weaning from mechanical ventilation. A better understanding of the related risk factors will help improve the care provided by nurses and medical personnel to patients undergoing the weaning process.

並列關鍵字

quality of sleep ； weaning ； mechanical ventilation ； respiratory care center

參考文獻

Astle, S.,Smith, D.(2007).Taking your patient off a ventilator.Registered Nurse.70(5),34-39.

Boles, J. M.,Bion, J.,Connors, A.,Herridge, M.,Marsh, B.,Melot, C.,Welte, T.(2007).Weaning from mechanical ventilation.European Respiratory Journal.29(5),1033-1056.

Branson, R. D.(2012).Modes to facilitate ventilator weaning.Respiratory Care.57(10),1635-1648.

Campbell, S. S.,Murphy, P. J.(2007).The nature of spontaneous sleep across adulthood.Journal of Sleep Research.16(1),24-32.

Chasens, E. R.,Sereika, S. M.,Weaver, T. E.,Umlauf, M. G.(2007).Daytime sleepiness, exercise, and physical function in older adults.Journal of Sleep Research.16(1),60-65.