拔管後呼吸窘迫使用非侵襲性呼吸器的效益探討

The effectiveness survey for patients use NIPPV to prevent post extubation respiratory distress

汪性寧(Hsing-Ning Wang)

指導教授 ： 蘇振隆

中原大學/工學院/生物醫學工程研究所/碩士(2010年)

https://doi.org/10.6840/cycu201000082

摘要

根據臨床統計顯示，拔管失敗常會導致併發症發生及死亡率的增加。為了保護使用侵襲性呼吸器之病人，免於因為拔管失敗及相關併發症之發生，本研究主要目的為找尋一些指標作為評估使用非侵襲性呼吸器（Noninvasive Positive Pressure Ventilators，NIPPV）的效益。一方面希望精準研判適當的脫離時機，二來可防止誤判使用NIPPV而延誤插管所帶來的傷害。
我們收集了北部某醫學中心加護病房拔管後使用NIPPV的74位病人的相關資料，選擇簡單易行的共病指數及相關變項，量化後作為的預測因子。以描述性、卡方、t 檢定及回歸等統計方法，分析拔管後呼吸窘迫使用NIPPV的病人，受共病指數高低及其他何種因子的干擾，會影響其脫離結果及死亡率。
本研究收案選擇非單一性疾病，使用NIPPV治療拔管後呼吸窘迫，發現成功改善的比例高達80%。研究中我們另外發現大多數病人平均年齡較大，且預期都具有一些共病，我們利用量化之共病指數分析這些共病對預後的影響。結果發現共病指數低（CCI≦4）的病人拔管後使用NIPPV協助脫離機械通氣成功的機會較高（PPV=87%）；共病指數高者( CCI＞4）拔管後呼吸窘迫使用NIPPV協助脫離機械通氣成功的機會較低（NPV=40%）。至於在院死亡的分析，得到的結果是共病指數＞7者：28天內在院死亡率為50%（Sensitivity）；共病指數≦7者：28天內存活率為100%（Specificity）。
初步結論為不論任何疾病，拔管後呼吸窘迫使用NIPPV普遍可以得到好的效果，而共病指數的確是預測拔管後使用NIPPV效果好壞的強力指標。未來如果將這些潛在的共病因素列入預後的考慮，NIPPV用於治療拔管後高風險或慢性阻塞型肺疾之呼吸衰竭患者，預測的效果會更精準。

關鍵字

非侵襲性陽壓呼吸器 ； 共病指數 ； 脫離 ； 呼吸窘迫 ； 慢性阻塞型肺疾

並列摘要

According to clinical statistics, extubation failure tends to result in elevated incidences of complications or mortality. To protect patients using invasive positive pressure ventilators from developing complications associated with extubation failure, the main purpose of this study was adopted to assess the benefits of using Noninvasive Positive Pressure Ventilators (NIPPV). Based on the results of the assessment, it has been anticipated that a proper weaning time could be precisely determined and that damages caused by the erroneous judgment of using NIPPV that delayed the process of intubation could also be prevented.
Data was collected from 74 intensive care unit (ICU) patients put on NIPPV after extubation at a medical center in northern Taiwan. The simple CCI was adopted as the quantitative predictor along with the following analysis methods: descriptive analysis, Chi-Square, t-test, and regression. Patients on NIPPV due to respiratory distress after extubation were analyzed to determine the weaning outcomes and mortality as affected by the CCI and other factors.
The study collected data from patients with more than one type of disease. After the patients were put on NIPPV due to respiratory distress after extubation, an 80% improvement rate was observed. During the study, it was also discovered that the average age of the majority of the patients was higher, and that the patients were expected to suffer from certain comorbidity. A quantitative CCI was employed to analyze the effects of the comorbidity on prognosis. The results showed that patients with a low CCI (CCI≦4), who were on NIPPV after extubation, tended to have a higher success rate of weaning off mechanical ventilation (PPV=87%). Those with a higher CCI (CCI>4), who were on NIPPV due to respiratory distress after extubation, tended to have a lower success rate of weaning off mechanical ventilation (PPV=40%). In terms of the analysis for nosocomial deaths, the result indicated that for patients with a CCI>7， the nosocomial mortality within 28 days was 50% (sensitivity); for those with a CCI≦7， the survival rate within 28 days was 100% (specificity).
Preliminary conclusions is that regardless of any disease, respiratory distress after extubation could be reduced by using NIPPV and that the CCI was indeed a powerful indicator for predicting the results of using NIPPV after extubation.If these potential comorbidity factors were taken into consideration when assessing the prognosis in the future, the prediction would be more accurate for patients put on NIPPV due to a high risk of respiratory distress after extubation or due to chronic obstruction pulmonary disease.

並列關鍵字

chronic obstructive pulmonary disease ； respiratory distress ； Charlson comorbidity index ； weaning ； noninvasive positive pressure ventilator

參考文獻

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