使用高頻振盪呼吸器病患之醫療資源利用分析

The Analysis of Medical Resource Utilization of Patients Using High-Frequency Oscillation Ventilator

鍾月枝(Yueh-Chih Chung) ； 黃梅珍(Mei-Chen Huang) ； 邢淑珍(Shu-Chen Hsing) ； 鄭高珍(Kuo-Chen Cheng)

《重症醫學雜誌》 14卷2期 (2013/04) Pp. 32-39

摘要

目的：國外研究發現，高頻振盪呼吸器（High-Frequency Oscillatory Ventilation, HFOV）可以降低呼吸器使用天數、改善患者氧合指數。本研究目的旨在探討HFOV使用病患之醫療資源利用及預測死亡之風險因子。方法：資料來源為2005年至2008年健保局住院申報資料，對象為成人加護病房使用HFOV之病患（健保申報碼57029c）。死亡定義為「轉歸代碼」『4』死亡、『A』病危自動出院且轉出ICU後24小時內辦理出院者。結果：本研究共收集173位使用HFOV病患，男性58.96％，女性41.04％，平均年齡60歲。病例組合指標（Case-Mix Index, CMI）為3.36，查爾斯合併症指數（Charlson Comorbidity Index, CCI）0分比率占39.31％、1分比率占26.01％及≧2分比率占34.68％。呼吸器脫離率29.80％。2005-2008年平均ICU死亡率、HFOV使用天數（p＜0.001）及住院費用有上升趨勢（p＜0.05）。預測HFOV使用病患死亡風險因子中，呼吸器是否脫離及HFOV使用天數，皆有顯著差異（p＜0.001）。結論：在年齡、性別及CCI無顯著差異下，平均HFOV使用天數上升且呼吸器脫離率卻呈現下降現象，顯示重症病患之醫療資源利用仍有待改善，使用HFOV宜審慎評估。

關鍵字

高頻振盪呼吸器 ； 氧合指數 ； 醫療資源利用 ； 低血氧症

並列摘要

Objectives: Overseas studies found that high-frequency oscillatory ventilation (HFOV) can reduce ventilator days, improve oxygenation in patients. This study aims to explore the utilization of medical resources, and predicting risk factors of mortality of patients using HFOV. Method: The data was from national health insurance (NHI) hospital claims data of patients admitted to adult intensive care unit, and ever using HFOV (code 57029c) from the year of 2005 to 2008. Mortality is defined as ＂outcome code＂ ＂4＂-mortality and ＂A＂-discharge in critical condition within 24 hours after leaving ICU. Results: Totally 173 patients with HFOV were collected, with male 58.96%, female 41.04%, mean age 60 years. Case-Mix Index (CMI) value was 3.36. Charlson Comorbidity Index (CCI) value was 0 for 39.31%, was 1 for 26.01% and≧2 for 34.68%. Mechanical Ventilation (MV) weaning rate was 29.80%. Average ICU mortality, HFOV using days (p＜0.001) and hospital expenses in (p＜0.05) had upward trend from 2005 to 2008. Branch of NHI bureau, MV weaning, HFOV use days and hospital expenses were all significant risk factors (p＜0.05) in predicting mortality in patients using HFOV. Conclusion: In this study, the CMI, CCI was no significant difference but average HFOV days and hospital expenses were increased and weaning rates were decline. It shows the medical resource utilization is needed to improve in such patients and should be carefully assessed using HFOV.

並列關鍵字

High-frequency oscillatory ventilation ； Oxygenation index ； Medical resource utilization ； Hypoxemia