zRisk Factors for Reintubation in Ventilator-Dependent Patients

呼吸器依賴病患再插管的影響因子

李綺婷(Chi-ting Li) ； 李明杰(Ming-chich Lee) ； 陳鼎達(Ting-Tat Chan) ； 陳志成(Solomon Chih-cheng Chen)

《呼吸治療》 15卷1期 (2016/01) Pp. 1-13

https://doi.org/10.6269/JRT.2016.15.1.01

摘要

目的：拔管失敗病患可能會導致死亡，本研究擬探討台灣長期依賴呼吸器的病患拔管後再插管的影響因子。方法：本篇為回溯性觀察型研究。研究對象為南台灣某區域教學醫院，收集2007 年1 月至2012年12 月，年齡大於17 歲且呼吸器使用≧21 天的病患為研究對象，共計375 位。其中成功拔管病患287 位，再插管病患有88 位。分別就病患的屬性包括年齡、性別、共病症、臨床特性、疾病嚴重度 (APACH II)、查爾森共病指數、生化檢查數據等作分析。結果：再插管病患呼吸器使用天數及加護病房(或亞急性呼吸照護病房)住院天數較長。以多變項羅吉氏迴歸分析發現高疾病嚴重度 (APACH II) 、低血紅素、高查爾森共病指數及敗血症，是影響病患再插管的因素。而多變項分析結果發現血紅素每增加1 g/dL 能顯著降低再插管機率17% (相對危險比 = 0.83；95%信賴區間0.68-0.91)。罹患敗血症者再插管機率增加為2.5倍 (相對危險比 = 2.54；95%信賴區間1.33-4.88)。結論：呼吸器依賴病患之疾病嚴重度、血紅素、查爾森共病指數及敗血症等四因素會顯著影響再插管機率。我們建議醫師在計畫性拔管前若讓病患維持較高血紅素值以及妥善預防敗血症發生，或許可以降低病患再插管之機率。

關鍵字

呼吸器依賴 ； 再插管 ； 拔管失敗 ； 血色素 ； 查爾森共病指數

並列摘要

Objective: Extubation failure in extubated patients may result in mortality. The objective of this study is to examine the risk factors for reintubation among long-term ventilator-dependent patients in Taiwan. Methods: This was a retrospective observational study. A total of 375 cases, including 287 successful weaning and 88 reintubation patients, aged older than 17 years and requiring more than 21 days of mechanical ventilation support, were identified from one district teaching hospital in southern Taiwan during 2007-2012. Their age, sex, comorbidities, clinical features, acute physiology and chronic health evaluation (APACHE) II score, Charlson Comorbidity Index (CCI) score, and biochemistry laboratory data were collected for analyses. Results: The reintubation group had more days of ventilator use and longer stays in the intensive care unit or respiratory care center. The multivariate logistic regression analysis found that higher APACH II score, lower hemoglobin concentration, higher CCI score and sepsis were associated with reintubation. The multivariate analysis revealed a 17% reduction in reintubation risk (adjusted odds ratio = 0.83; 95% confidence interval 0.68-0.91) for each one g/dL increase in hemoglobin concentration, but 2.5 times increase in reintubation risk (adjusted odds ratio = 2.54; 95% confidence interval 1.33-4.88) for patients with sepsis. Conclusions: The APACH II score, hemoglobin concentration, CCI score and sepsis are four factors significantly associated with reintubation. Preventing sepsis and maintaining hemoglobin concentration at a higher level may reduce the risk of reintubation, which can help clinicians be better prepared for planned extubation.

並列關鍵字

ventilator-dependent ； reintubation ； extubation failure ； hemoglobin ； Charlson Comorbidity Index