臺灣呼吸器使用病患執行氣管切開術之結果分析

The outcomes analysis of ventilator patients with tracheostomy in Taiwan

目的：呼吸器使用病患日漸高漲的醫療費用，是造成健保財務窘迫原因之一。積 極呼吸器脫離是病患及健保局首要目標。研究顯示，接受過氣管切開術後病患，呼吸 器脫離率提高、ICU天數及住院費用降低。本研究希望提供呼吸器使用病患執行氣切 之醫療資源利用，並預測氣切患者死亡風險因子。 方法：資料來源為2004年3月1日至2009年2月28日中央健保局住院申報資料，對象 為加護病房使用呼吸器且執行氣切，年齡≧18歲之病患。 結果：本研究共收集522,438位呼吸器使用病患，其中共有32,419位接受過氣 切。男性22,757位（70.2%），平均年齡68歲，RW值4.76。2004-2008年期間，呼吸 器使用病患執行氣切比率呈現逐年下降現象。醫學中心氣切率最高（47.4%）呈現上 升現象，而地區醫院最低（14.0%）呈現逐年下降趨勢（P for trend<0.001）。ICU天 數、呼吸器使用天數及抗生素費用均呈現逐年下降趨勢（26.2~23.6天；2 .8~25天； 124, 43~72,772元，P for trend<0.001）。台北分局氣切率最高（28.7%），東區分局最 低（4.1%）。地區醫院氣切病患死亡風險是醫學中心的1.23倍（OR: 1.23, P<0.001）。 結論：氣切病患RW值雖呈現上升現象，但平均ICU天數、呼吸器使用天數、抗生 素費用則逐年下降，整體呼吸器使用且執行氣切病患資源利用有改善趨勢。

Objectives: The highly increase of medical cost of ventilator patients is one of the main reasons causing financial distress in health care system. Ventilator weaning is the primary goal of critically ill patients with ventilators and National Health Insurance Bureau. Some studies showed that patients with tracheotomy have higher weaning rate, shorter ICU days and lower hospital costs. This study aims to provide the medical resource utilization and predicting factors of mortality of ventilator patients with tracheotomy. Methods: The data base was from National Health Insurance hospital claims data of patients admitted to intensive care unit, age ≧18 years, receiving mechanical ventilation and tracheotomy from March 1, 2004 to February 28, 2009. Results: Totally 522,438 patients using ventilator were collected. Among them, 32,419 patients received tracheostomy, 22,757 (70.2%) were male. The average age was 68 years, RW value was 4.76. Using ventilator patients with tracheotomy showed yearly declining during calendar years 2004-2008. The tracheostomy rate (47.4%) was highest with rising tendency in medical centers and lowest (14.0%) with declining trend (P for trend<0.001) in the district hospitals. ICU days, ventilator days and the cost of antibiotics also showed a declining trend (26.2~23.6 days; 29.8~25 days; 124,943-72,772 dollars, P for trend<0.001). By distribution of regions, the tracheostomy rate was highest (28.7%) among the hospitals of Taipei Branch and lowest (4.1%) in Eastern Branch. The risk of mortality of tracheostomy patients in district hospital is 1.23 times compared with the medical center (OR: 1.23, P<0.001). Conclusion: Our study showed in the situation of increase of RW, but the ICU days, ventilator days, antibiotic costs decreased yearly. It indicates the improvement of overall medical resource utilization in the patients of using ventilators with tracheostomies.