呼吸器依賴患者之預後與相關因子研究

Clinical outcomes and related factors of ventilation-dependent patients

張伶萱(Ling-Hsuan Chang) ； 張蕙明(Hui-Ming Chang) ； 蔡珮詩(Pei-Shin Tsai) ； 郭美梅(Mei-Mei Kuo) ； 江梅(Mei Chiang)

《呼吸治療》 21卷1期 (2022/01) Pp. 1-13

https://doi.org/10.6269/JRT.202201_21(1).0001

摘要

前言：由於急重症醫學及呼吸器的進步，造成急重症慢性化及需要長期插管呼吸照護（Prolonged Mechanical Ventilation, PMV）之呼吸器依賴病患的長期照護問題，於2000年引進呼吸照護中心（RCC）及呼吸照護病房（RCW）等作法，紓解在急性加護病房之照顧問題。我們試圖以這些病患之病歷資料進行其預後分析（包含脫離呼吸器及存活率）。研究方法設計：以本院之RCW呼吸器依賴病患為研究對象進行回溯性研究，收集2017－2018之PMV病患病歷資料，單變量分析中使用卡方檢定或費雪精確檢定，進一步在多變量分析中，找出脫離呼吸器之相關因子，用Cox比例風險模式找出RCW病患存活之相關因子進行預後及相關因子分析。結果：2017至2018年入住RCW，長期呼吸器依賴之病患共52人，男性較多，入住RCW平均年齡73.9歲，平均住院天數190天，觀察至2019.12.31，呼吸器脫離成功有16人，成功比率為30.8%，一年存活率為47.0%，平均存活時間為9.68個月。脫離呼吸器：在多變量分析中慢性病族群裡營養足夠（Albumin≥3.5）的病患成功脫離呼吸器的勝算比是營養不良的5倍。存活率：入院時年齡每增加一歲，入住RCW後會死亡的危險性增加5%；入院時APACHE每增加一分，死亡的危險性增加9%；住院期間曾上轉ICU的病患，死亡的危險性是未曾上轉ICU的6.47倍。結論：本研究發現在RCW中成功脫離呼吸器之顯著相關因子為營養狀況，而跟存活率相關之因子則為入院時年齡與APACHE分數、住院期間是否曾上轉ICU；這些因子可以提供我們評估RCW的病人脫離呼吸器及存活率的重要參考指標。

關鍵字

長期插管呼吸照護 ； 存活 ； 拔管 ； 呼吸照護中心 ； 呼吸照護病房

並列摘要

Introduction: Patients requiring post-ICU prolonged mechanical ventilation (PMV) are rapidly increasing in number, as improved ICU care has resulted in improved survival of many patients, but such patients require PMV treatment after transfer into RCC/RCW (respiratory care center/respiratory care ward), which make a sustained big financial burden to the National Health Insurance. The objective of this study is to determine the clinical outcomes and related prognostic factors for PMV patients in one teaching hospital of central Taiwan, 2017-2018. Material and methods: Retrospective review of medical records was performed to determine the major risk factors for clinical outcomes (successful weaning and survival) for post-ICU PMV patients in Taiwan. Chi-squre test or Fisher's precise test was used in univariate analysis. In multicariate analisis, Find out the relevant factors of detachment from the ventilator, use the Cox proportional hazards model to find the relevant factors of RCW patient survival for prognosis and relevant factor analysis. Results: There were 52 patients of PMV during 2017 to 2018 in RCW. The majority were male (65.4%) and median age was 73.9 years old. Median admission days were 190. Among these patients, number of successful weaning was 16 (30.8%). One year survival rate was 47.0% and median survival time was 9.68 months. Successful weaning: In the group of having chronic disease, odds ratio of good nutrition status (albumin≥3.5) was five compared with another group. Survival rate: Hazard ratio of age when admission, APACHE score and ever transferred to ICU were 1.05 (increased by 5% risk of death with increase by adding 1 year old), 1.09 (increased by 9% risk of death with increase by adding 1 score) and 6.47 (6.47 fold risk compared with never transferred to ICU), respectively. Conclusions: Nutrition status significantly affected rate of successful weaning. Age when admission, APACHE score and ever transferred to ICU were significant prognostic factors of survival rate. Thus, these results could provide important predicting index when accounting for rate of successful weaning and survival in RCW.

並列關鍵字

Prolonged mechanical ventilation ； survival ； successful weaning ； respiratory care center ； respiratory care ward