呼吸衰竭之神經外科患者預後因子探討

Prognostic factors for neurosurgery patients with respiratory failure

黃恬琳(Tien-Lin Huang)

指導教授 ： 蔡忠榮

高雄醫學大學/醫學院/醫學研究所碩士班/碩士(2020年)

摘要

研究目的及背景：腦部損傷是常見導致神經外科患者死亡或是失能的疾病之一，嚴重者會延長病患在加護病房和住院的時間，延緩呼吸器脫離時間，加上共病症等其他原因會影響患者認知功能和日常生活機能恢復的狀況。本篇研究以病歷回溯的方式收集高雄醫學大學附設中和紀念醫院神經外科加護病房個案，去探討呼吸衰竭之神經外科患者預後因子。
研究方法: 本研究收集符合神經外科手術後呼吸衰竭插管個案之臨床基本資料，包含性別、年齡、身高、體重、手術三天病程呼吸器的數值、顱內超音波變化和預後狀況去分析之間的關聯性。
結果: 回溯病歷期間為民國106年10月1日起至107年12月31日，共收案85位病患去分析影響初期預後指標(呼吸器使用天數、住院天數)和死亡率的潛在原因。結果顯示患者術後三天平均昏迷指數、顱內壓、成功拔管率、是否進行氣切手術以及共病症和手術原因對初期預後指標會有顯著的影響；會影響死亡率的變項有個案體重、身體質量指數、術後三天平均昏迷指數、顱內壓以及顱內超音波中的血液搏動值，其中以顱內壓為最佳的預測指標，AUC數值為0.87，而呼吸器模組設定條件皆未達統計上顯著意義。
結論: 從統計上來看病患本身臨床指標和潛在疾病對神經手術患者的預後有顯著影響，而呼吸治療設定方面則無影響；顱內壓和顱內超音波中的搏動數值為死亡率良好的預後指標，因此在臨床處置上可藉由此研究結果提供有效的治療方針改善神經手術術後患者的預後。
關鍵字:神經手術、呼吸衰竭、機械通氣、顱內超音波、死亡率

關鍵字

神經手術 ； 呼吸衰竭 ； 機械通氣 ； 顱內超音波 ； 死亡率

並列摘要

Background and purpose: neurosurgery patients usually need to be intubated with mechanical ventilator. This management could help patients to breathe due to neurosurgery and reduce arterial carbon dioxide pressure which can decline the expansion of cerebral blood vessels and avoiding second-degree brain damage. This clinical treatment mentioned above is expected to provide a support therapy, diminish brain damage and improve its prognosis. In this study, we applied the electronic medical record system retrospectively for neurosurgery patients in the neurosurgery intensive care unit in Kaohsiung Medical University Chung-Ho Memorial Hospital (KMUHIRB-E(I)-20190311). We investigated the prognostic factors of patients with neurosurgery and improve the clinical management.
Methods: The basic data of enrolled cases were collected, including the gender, age, height, weight, surgical procedure, the duration of admission and mechanical ventilator. The data was analyzed via Statistical Product and Service Solutions (SPSS) and examine the correlation between medical factors and prognostic status.
Results: A total of eighty-five patients were enrolled in our study. We aim to identify the variables which could affect primary outcome variables, including the using days of mechanical ventilator, the stays of intensive care unit and admission days, and mortality. Our results showed that average Glasgow Coma scale three days after neurosurgery, intracranial pressure, the rate of successful extubation, comorbidities, cause of brain injury and whether the patient did tracheostomy or not could affect the primary outcome variables； body weight, body mass index, average Glasgow Coma Scale three days after neurosurgery, intracranial pressure and pulsatility index value of Transcranial Doppler are involved in the mortality. Among these variables, intracranial pressure is the best predictor to evaluate the outcome of brain injury, with an AUC value of 0.87. However, the ventilator setting of the respiratory module is not statistically significant.
Conclusion: The neurosurgery patient's underlying diseases and the causes of brain injury have significant impact on the prognosis of the length of hospitalization. In terms of respiratory therapy treatment and the adjustment of ventilator settings had no effects on outcome; both the average intracranial pressure and the data of Transcranial Doppler are suitable predictors for mortality. Therefore, the results of this study can contribute to the clinical treatment and provide an effective strategy to improve the prognosis and postoperative life of neurosurgery patients.
Key words: neurosurgery; Respiratory failure; Mechanical ventilation; Transcranial Doppler; Mortality

並列關鍵字

neurosurgery ； Respiratory failure ； Mechanical ventilation ； Transcranial Doppler ； Mortality

參考文獻

參考文獻

References

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2. Dong, M., et al., Compare the effect of noninvasive ventilation and tracheotomy in critically ill mechanically ventilated neurosurgical patients: a retrospective observe cohort study. BMC Neurol, 2019. 19(1): p. 79.

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