某醫學中心亞急性呼吸照護病房氣切病人早期氣切與呼吸器脫離之關係探討

The Association between Early Tracheostomy and Weaning from Mechanical Ventilation in Patients in a Sub-acute Respiratory Care Ward in a Medical Center.

戴雪萍(Hsueh-Ping Tai)

指導教授 ： 呂筑韻

義守大學/醫學院/醫務管理學系/碩士(2016年)

摘要

背景目的: 呼吸衰竭病人需藉由氣管內插管接呼吸器使用，若短時間內無法移除氣管內管時，建議進行氣管切開術，增加脫離呼吸器的機會。本研究是針對在本院氣管經喉插管之後長期使用呼吸器（prolonged mechanical ventilation）病人轉入亞急性呼吸照護病房（respiratory care center, RCC）後氣切執行時間(14天內 vs. 超過14天)與成功脫離呼吸器的關係。進行分析，據此了解包括人口學變項、生化檢查值、和這類病患是否成功脫離呼吸器的預後相關性。
方法:本研究採病歷回溯性調查，收集2014年4月1日起至2015年4月31日止醫學中心亞急性呼吸照護病房符合條件之病人病歷資料。符合研究的收案條件：(1)於入院期間執行氣管造口手術病患病人；(2)收案條件為滿18歲。探討早期氣切的人口學變項、血液生化抽血值有無影響脫離呼吸器及預後，結果包括呼吸器脫離成功和失敗百分比及加護病房住院天數、RCC住院天數、使用呼吸器天數及住院總天數。
結果:此研究共收案136名RCC患者，小於14天接受氣切者共57人，大於14天者共79人，早晚期氣切的人口學變項中呼吸衰竭到開氣切時間 (10±3.13天vs. 23.46±7.9天，p＜0.05)。早、晚期開氣切者加護病房天數、RCC天數、住院總天數、呼吸器使用天數分別為16.33±1.1天、20.09±2.1天、51.35±2.8天、34.07±2.5天。早期開氣切者（<=14天）相較於晚期開氣切者（＞14天）的加護病房天數、住院總天數、呼吸器使用天數較短，具顯著差異(p<0.05)。
結論: 在亞急性呼吸照護病房生化抽血值K離子、 BUN值、 Cr值 、Albumin數值對於脫離呼吸器有顯著影響。成功脫離呼吸器的相關因子包括有早期氣切、K離子、 BUN值、 Cr值 、Albumin數值、加護病房天數、住院總天數、呼吸器使用天數。早期氣切可縮短加護病房及住院總天數及減少呼吸器使用天數，更可加速呼吸器脫離。

關鍵字

氣管造口 ； 脫離呼吸器 ； 亞急性呼吸照護病房

並列摘要

Background and Purpose: Respiratory failure patient are in needs of using an endotracheal tube connected to a respirator, endotracheal tube that cannot be removed within a short time. Tracheostomy is commonly recommended in order to increase the possibility of successful weaning from mechanical ventilation. The purpose of the current study was to examine the difference between patients with early (<=14 days) and late (>14 days) tracheostomy in terms of their demographic variables, laboratory data, and rate of weaning from mechanical ventilation in patients with prolonged mechanical ventilation in sub-acute respiratory care center (RCC).
Methods: The study was a retrospective chart review study, using data from patients in RCC between 2014/04/01 and 2015/04/31. Subject inclusion criteria were: patients (1) received tracheostomy during this hospitalization and (2) were 18 years or older. Dependent variables were demographics and lab results, and outcome variables were successful rate of weaning from mechanical ventilator, days in intense care unit (ICU), days in RCC, days of mechanical ventilator used, and total days of hospitalization.
Results: A total of 136 RCC patients were met the inclusion and exclusion criteria. Based on the time of tracheostomy was performed since patients were determined in need of mechanical ventilation, subjects were divided into early(<=14 days) and late (>14 days) tracheostomy groups. There were 57 subjects in early tracheostomy group, and 79 in the late group. The average of days of subjects having tracheostomy in the early group was 10 days (standard deviation, SD 3.13 days) versus 23.46 days (SD 7.9 days) in the late group, which showed a significant difference (10±3.13 vs. 23.46±7.9, p＜0.05). Compared with the late group, subjects in the early group were reported to have significantly less days in ICU, hospitalization, and of mechanical ventilation used. Lab data, including K+, blood urea nitrogen (BUN), creatinine, albumin, were significantly associated with weaning from mechanical ventilator.
Conclusions: Various variables were associated with weaning from mechanical ventilation, including early time of receiving tracheostomy, K+, BUN, creatinine, albumin, days in ICU, and days of hospitalization, days of mechanical ventilator used.

並列關鍵字

Tracheostomy ； Ventilator weaning ； sub-acute respiratory care ward

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