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題 名 | 計劃性拔管與非計劃性拔管病人之預後=The Prognosis of Planned Extubation and Unplanned Extubation Patients |
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作 者 | 許重梅; 張炎德; 魏美觀; 李寶琳; 林英芬; 林惠釧; | 書刊名 | 呼吸治療雜誌 |
卷 期 | 12:2 2013.07[民102.07] |
頁 次 | 頁17-27 |
分類號 | 415.415 |
關鍵詞 | 非計劃性拔除氣管內管; 格拉斯哥氏昏迷量表; 疾病嚴重度; Unplanned endotracheal tube extubation; UEE; Glasgow coma scale; GCS; APACHE Ⅱ; |
語 文 | 中文(Chinese) |
中文摘要 | 目的:非計劃性拔除氣管內管是重症單位醫療品質重要指標,但其屬非預期的醫療過程,且比率並不低,因此這議題對於呼吸器病人的預後及相關影響是值得探討。故本研究主要探討成人重症單位計劃性拔管與非計劃性拔管病人,個人屬性、拔管狀態及預後的比較。方法:以北區某(875床的)區域教學醫院成人重症單位病人為研究對象,針對2008年1月1日至2009年12月31日期間,年齡大於18歲之呼吸衰竭、重大手術與重症病人,接受氣管內管使用呼吸器治療者進行資料收集。共計113位非計畫性拔管病人及電腦隨機抽取5個成人重症單位共200位計畫性拔管病人進行統計分析。結果:病人的個人屬性中非計畫性拔管者的格拉斯哥氏昏迷量表指數顯著高於計畫性拔管者(P<0.0001),疾病嚴重度顯著低於計畫性拔管病人(P=0.0006)。拔管狀況:非計劃性拔管發生在呼吸器脫離訓練期間的病人,有53.3%需要再插管,拔管後須重新插管的時間,顯著低於計畫性拔管病人(P<0.0001)。預後:非計畫性拔管者,拔管後重插病人比率統計上顯著高於計畫性拔管(P<0.0001),拔管後失敗病人有89%在12小時內需要再插管。非計畫性拔管的死亡率顯著高於計畫性拔管(P=0.0027),其中拔管成功與失敗比較,發現失敗者的死亡率(P=0.0282)、呼吸器使用總天數(P<0.0001)及加護病房住院總天數(P=0.0016)均顯著高於成功者。結論:非計畫性拔管病人發現易發生在非自發性呼吸模式,氧氣濃度約在45%、格拉斯哥氏昏迷指數約在8.96與疾病嚴重度約在22.59的病人,即使在呼吸器脫離訓練期間自拔的病人,仍有53.3%需要再插管。非計畫性拔管病人拔管後有較高的重插失敗率與死亡率,而且拔管失敗病人較成功病人,有較高的死亡率、呼吸器使用總天數及加護病房住院總天數,因此須主動採取措施,預防呼吸器病人非計畫性拔管。 |
英文摘要 | Aim: Unplanned endotracheal tube extubation (UEE) is an important index for medical quality in critical care. However, UEE is not predicting medical process, and not lower population. Therefore, this issue is worthily study in the outcomes and related effect of ventilator patients. This study have compared with clinical characters, extubation status and the prognosis of planned and extubation and unplanned extubation patients. Method: The study was processed in an 875-bed local teaching hospital in northern of Taiwan. The patients were admission between 2008/1/1~2009/12/31 for major operation or critical care, older than 18 years old, and respiratory failure with ventilator support. From five adult ICU, total 133 UEE patients and 200 planned endotracheal tube extubation patients were selected for statistic analysis. Result: About characteristics of patients, UEE patients had higher Glasgow coma scale (8.96±1.25 vs 8.33±1.46, P<0.0001) and lower APACHE II (22.59±9.53 vs 27.93±17.91, P=0.0006) than planned endotracheal tube extubation patients. About extubation status among weaning training, still 53.3% UEE during weaning training patients still need re-intubation and the time from extubation to re-intubation was shorter than planned endotracheal tube extubation patients (P<0.0001). About prognosis, the percentage need re-intubation was higher among UEE patients (P<0.0001) and 89*% weaning failure cases need re-intubation within 12 hours. The mortality of UEE patients was higher than planned endotracheal tube extubation patients (P = 0.0027). Higher mortality (P = 0.0282), longer ventilator days (P<0.0001) and long ICU days (P=0.0016) was found among weaning failure than weaning successful cases. Conclusion: It was found that UEE patients were susceptible for non-spontaneous mode, FiO2 around 45%, Glasgow coma scale 8.96 and APACHE II 22.5. Still 53.3% UEE during weaning training patients need re-intubation. UEE patients had higher re-intubation rate and mortality. Weaning failure cases had higher mortality, longer ventilator days and long ICU days. Therefore, some aggressive intervention should be made to prevent UEE in ventilator patients. |
本系統中英文摘要資訊取自各篇刊載內容。