臺灣呼吸器使用患者之心生理因子與呼吸器脫離之相關性

The Correlation between Psychophysiological Factors and Ventilator Weaning in Mechanical Ventilated Patients in Taiwan

目前相關呼吸器脫離研究較著重於預測生理指標之探討，對於病患的心理層面之問題，卻甚少研究探討。所以，本研究目的主要探討恐懼、焦慮程度、呼吸困難等心理感受及呼吸快淺生理指數對患者呼吸器脫離結果的相關性。此為前瞻性調查研究，於2007 年6 月至2008 年6 月間，對於台北某家醫學中心之加護病房進行收案。共計104 位呼吸器使用患者，接受問卷、數字量表及呼吸參數測定儀之檢測，反映他們於接受呼吸器脫離時之恐懼、焦慮、呼吸困難感受、呼吸快淺指數、及每分鐘通氣量，所需呼吸器之使用天數則紀錄為呼吸器脫離結果。於104 位參加本研究個案中，完整收集之有效問卷為103 份。研究指出個案的情緒性恐懼（4.6 ± 3.5）及意識性恐懼（3.0 ± 2.9）分別與其焦慮感受（4.5 ± 3.3）及呼吸困難感受（3.7 ± 2.8）有顯著相關（p＜0.05），而且心理焦慮與呼吸困難感受呈現顯著相關（ r = 0.329， p＜0.05），但與呼吸快淺指數及呼吸器使用總天數無統計上之顯著相關（p＞0.05）；個案之呼吸困難感受與呼吸快淺指數有正相關（r = 0.198， p＜0.05），但與呼吸器使用天數無統計上之相關。呼吸快淺指數是唯一與呼吸器使用總天數正相關的指標（r = 0.275， p＜0.05）。心理恐懼與焦慮程度對於呼吸器之使用總天數並無顯著相關，但與呼吸困難感受呈現正相關。同時，呼吸困難感受與影響呼吸器使用總天數最顯著之呼吸快淺指數呈現正相關，此結果將可提供臨床醫療照護人員對於呼吸器使用病患治療照顧時之參考。

Contemporary studies related to mechanical ventilation weaning are typically more focused on exploring physiological weaning predictors than psychological weaning predictors. The purpose of this study was to explore correlations among psychophysiological factors of fear, state anxiety, dyspnea, and rapid shallow breathing index (RSBI) and the weaning outcome in mechanical ventilated patients. This was a prospective study. There were104 subjects recruited from intensive care units (ICUs) of a medical center in Taipei, June 2007 to June 2008. These subjects were asked how they were feeling of fear, state anxiety, and dyspnea at the time of ventilator weaning by responding to state anxiety inventory and numerical rating scales. The data of rapid shallow breathing index, minute ventilation, and the length of mechanical ventilation were measured by ventilation monitor (ventcheck) and follow-up recorded, respectively. 103 out of 104 subjects completed the participation in this study. Subjects’ emotional fear (4.6 ± 3.5) and cognitive fear (3.0 ± 2.9) significantly correlated with their anxiety (4.5 ± 3.3) and dyspnea (3.7 ± 2.8) (p＜0.05). A positive correlation was found between subjects’ anxiety and dyspnea (r = 0.329, p＜0.05), but there was insignificant correlation between their anxiety and RSBI (p＞0.05), or their anxiety and LOMV (p＞0.05). The level of subjects’ dyspnea significantly correlated with their RSBI (r = 0.198, p＜0.05). RSBI was the only one index to predict the LOMV (r = 0.275, p ＜0.05). Subjects’ psychological factors of fear and anxiety did not have significant correlations with their length of mechanical ventilation, but did have significantly positive correlation with dyspnea. However, dyspnea did have a significant correlation with RSBI, which was the most powerful predictor of the length of mechanical ventilation. Results from this study provide a direction for health care providers to consider when managing the care of mechanical ventilated patients.