非侵入性正壓通氣應用於急性呼吸衰竭拔管之成效

The Performance of Non-invasive Positive Pressure Ventilation Applied in Acute Respiratory Failure after Extubation

沈慧怡(Hui-I Shen)

指導教授 ： 葉德豐

中臺科技大學/管理學院/健康產業管理研究所/碩士(2011年)

摘要

摘要
背景：呼吸衰竭案例併氣管內管插管在醫院層出不窮的發生，據文獻指出拔管後失敗需重插管者，無論是死亡風險、醫院住院天數、醫療費用和院內肺炎感染等都明顯增加，故提昇拔管成功率等醫療品質便成為當今重要的議題。
目的：本研究藉由分析拔管前病患資料、脫離指標測試與拔管後選擇的不同呼吸照護方式間相關因素，探討拔管後使用非侵入性正壓通氣而脫離成功的相關指標以及品質指標之差異性，藉以提昇照護品質並作為日後實務上作業流程制定上的考量依據。
方法：以病歷回溯性的方式，收集台中某區域級教學醫院98年1月至99年12月呼吸衰竭拔管後病患，研究組為拔管後使用非侵入性正壓通氣，對照組為拔管後使用氧氣，符合選樣總樣本數為157人， 研究資料以描述性統計求得樣本平均數、百分比、次數分配等，再以卡方檢定、獨立樣本t檢定、羅吉斯迴歸、複迴歸等方法進行資料分析。
結果：顯示研究組的年齡較大、插管天數較長及意識狀態較差，兩組在控制病患臨床特性和脫離參數後在脫離成功、死亡、罹患肺炎和重插管無顯著性差異，研究組在拔管後加護病房住院日和拔管後總住院日顯著長於對照組。
結論：年齡大、插管天數長、意識狀態較差的病患，在拔管後常見需使用非侵入性正壓通氣的輔助，其最後的結果能確保條件較差的病患減少因拔管失敗所導致的合併症，故建議此類病患能在拔管後即時的預防性使用。
關鍵字：呼吸衰竭、脫離指標、非侵入性正壓通氣、重插管

關鍵字

脫離指標 ； 非侵入性正壓通氣 ； 重插管 ； 呼吸衰竭

並列摘要

Abstract
Background: Patients of respiratory failure with endo trachea intubation emerged in an endless stream in the hospital. According to the literatures, re-intubation resulting from extubation failure would increase death risk, length of stay, medical expense, and nosocomial. Therefore, extubation success rate has become an important issue in quality of care.
Objectives: This study aimed to identify the association between the successful-weaning of non-invasive positive pressure ventilation after extubation and related-quality indicators by analyzing the correlation of patient characteristics before extubation, weaning parameters and two different methods for respiratory care after extubation. The results would provide the direct that prompted quality of care and set up the standard process.
Method: A retrospective study collected medical records data of patients who were respiratory failure after extubation in a regional teaching hospital in Taichung from January, 2009 to December, 2010. The study group was patients who used non-invasive positive pressure ventilation after extubation , those who used oxygen after extubation were defined in control group. 157 cases were qualified in this study finally. Statistical methods included descriptive statistics, Chi-square test, independent samples t-test, logistic regression, and multiple regression analysis.
Results: Patients in study group were older, longer days of intubation and poor score of consciousness than the control group. There was no significant difference between two groups in the success of extubation, death, re-intubation, and pneumonia after controlling the patient characteristics and weaning parameters. However, the study group had longer length of stay in ICU after extubation and total length of stay after extubation than the control group.
Conclusion: To reduce complications occurred in poor condition patient, those who are older, longer days of intubation and poor score of consciousness have more necessity to use the non-invasive positive pressure ventilation after extubation. Non-invasive positive pressure ventilation can be used for preventive purpose after extubation immediately.

Keywords: respiratory failure, weaning index, non-invasive positive pressure ventilation, re-intubation

並列關鍵字

respiratory failure ； re-intubation ； non-invasive positive pressure ventilation ； weaning index

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