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頁籤選單縮合
題 名 | Unplanned Extubation in Surgical Patients: Clinical Outcomes and Risk Factors for Reintubation=外科病患的非預期性拔管:危險因子及預後分析 |
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作 者 | 呂明憲; 鄭宇凱; 王定中; 黃文詩; 邱麗櫻; 黃耀廣; 蔡熒煌; | 書刊名 | 胸腔醫學 |
卷 期 | 27:5 2012.10[民101.10] |
頁 次 | 頁270-275 |
分類號 | 415.415 |
關鍵詞 | 呼吸器; 非預期性拔管; 再插管; Unplanned extubation; Reintubation; |
語 文 | 英文(English) |
中文摘要 | 前言:呼吸器的運用在任何現代重症加護病房是日常活動的一部分。氣管插管,是用於提供安全的呼吸通道及有效的呼吸器的運用的主要途徑。當導致呼吸衰竭的疾病或手術情況穩定後,可考慮脫離呼吸器。外科病患通常在接受重大或高風險的手術後因需要血流動力學監測而轉住加護病房。這些患者通常在加護病房的停留時間較短。不幸的是,非計劃性的拔管,仍然會造成某些病人有較複雜的病程。非計劃性的拔管對外科病患影響尚未有詳細的探討。此論文是探討外科病患在非預期性拔管之後再插管的發生率,危險因子及臨床上之預後。設計:採回溯性病歷及電子資料檢閱分析。資料與方法:在此回溯分析研究中之成人病患,皆於2007年1月至2009年12月間於長庚紀念醫院嘉義分院,外科及腦神經外科加護病房住院。本研究中分析病患病歷及加護病房委員會交叉比對之電子資料。結果:從2007年1月至2009年12月總共有2,165位插管病患。本研究收錄42位病患(共50次非預期性拔管)。其中有29位男性病患,平均年齡為61.4歲。這50次非預期性拔管中,有42次是蓄意的(84%)。單變量的分析顯示:意外性非預期拔管(p=0.03),使用人工呼吸器時間(p=0.021)及PaO2/FIO2比值(p=0.002)等因子與非預期性拔管後再插管有關。多變量的分析結果顯示:意外性非預期拔管(p=0.004)及PaO2/FIO2比值(p ≤ 0.001)仍然是再插管的危險因子。需要再插管的病患中,71.4%的病患需要在一小時內再插管。再插管使病患的加護病房及總住院平均天數增加11.7及31.0天。此外,再度插管與加護病房住院天數(p<0.001),總住院天數(p<0.001),及死亡率(p<0.001)有極強烈的相關。結論:在外科病患中,非預期性拔管是個發生率低的突發事件;而再度插管通常發生在非預期性拔管一小時內。意外性非預期拔管常需要再度插管。 |
英文摘要 | Objectives: To determine the clinical outcomes of unplanned extubation (UE), and the incidence and risk factors of reintubation in surgical patients.Design: Retrospective medical chart and electronic database review.Materials and Methods: All adult patients admitted to the Surgical and Neurosurgical Intensive Care Unit of Chang Gung Memorial Hospital, Chiayi, from January 2007 to December 2009 were included. The medical charts and electronic records, cross-matched with the quality practice database of the Critical Care Audit Committee, were reviewed.Results: There were 50 episodes of UE involving 42 patients (29 males) from among 2,165 intubated patients during this period. The median age was 61.4 years. UE was categorized as intentional in 42 episodes (84%). The following factors were associated with reintubation in univariate analysis: accidental UE (p=0.03), time on mechanical ventilation (p=0.021), and PaO2/FIO2 (p=0.002). In multivariate analysis, accidental UE (p=0.004) and PaO2/FIO2 (p≤0.001) remained as significant risk factors for reintubation. Reintubation was mandatory in 71.4% of patients within 1 hour of UE. Reintubated patients spent an average of 11.7 more days in the intensive care unit (ICU) and had 31.0 more days of hospital stay. Reintubation correlated strongly with ICU stay (p<0.001), hospital stay (p<0.001) and mortality (p<0.001).Conclusion: The incidence of UE in surgical patients is low. Reintubations occur more frequently within one hour of UE. Accidental extubations are more likely to require reintubation. |
本系統中英文摘要資訊取自各篇刊載內容。