亞急性呼吸照護病人呼吸器脫離之相關影響因素──回溯性病歷查閱研究

Factors Related to Successful Ventilator Weaning in Respiratory Care Center Patients: A Retrospective Chart Review Study

背景：亞急性呼吸照護病房為呼吸器依賴病人接後續慢性呼吸照護的重要中繼站，目前針對亞急性呼吸照護病房呼吸器脫離的相關文獻相對較少，如何協助病人成功脫離呼吸器是照護團隊的首要挑戰，對於臨床照護與呼吸器脫離成功率的提升具有臨床意義。目的：本研究目的為瞭解亞急性呼吸照護病房病人呼吸器脫離情形及其影響因素，以提升呼吸器脫離的成效，減少家庭及醫療照護的負擔。方法：為回溯性病歷研究，以2016年1月至2019年12月研究期間入住亞急性呼吸照護病房進行呼吸訓練的病人為對象，資料來源為長庚醫學研究資料庫之健保次級資料，使用自製抄錄表進行資料收集，以逐步邏輯斯迴歸法探討基本屬性、疾病特性、生理指標及營養狀態與呼吸器脫離成功之相關影響因子。結果：本研究對象之呼吸器脫離率為78.5％，經雙變項分析後發現意識狀態、疾病嚴重度、呼吸快淺指數、亞急性呼吸照護病房住院天數、呼吸器使用天數、血中尿素氮、白血球、血紅素、血中白蛋白及平均攝取熱量與脫離呼吸器成功有顯著相關性。亞急性呼吸照護病人呼吸器脫離的預測因子為疾病嚴重度、呼吸快淺指數、呼吸器使用天數、白血球與血紅素等五個因素。結論／實務應用：呼吸器依賴者應盡早介入評估，並將結果列入常規檢驗監測項目、依個別性提供脫離呼吸器計畫，進而成功脫離呼吸器，以減少家庭及醫療照護的負擔。

Background: The subacute respiratory care unit is an important relay station where respirator-dependent patients may access subsequent chronic respiratory care. Although there is relatively little information in the literature regarding respirator disconnections in subacute respiratory care units, assisting patients to disconnect successfully from respirators is a primary challenge for care teams. Purpose: The purpose of this study was to understand respirator disconnections and the factors affecting these events in subacute respiratory care units to improve the effectiveness of ventilator weaning and reduce the burden on families and medical care providers. Methods: This was a retrospective chart review study. Patients admitted to the subacute respiratory care unit for respiratory training during the study period from January 2016 to December 2019 were recruited as subjects and the data were collected from the Chang Gung Medical Research Database’s health insurance secondary data using a self-made transcription form. Results: The ventilator weaning success rate of the subjects in this study was 78.5%. A bivariate analysis revealed that consciousness status; disease severity; rapid shallow breathing index; days of hospitalization in a respiratory care center; days of ventilator use; blood urea nitrogen, white blood cell, hemoglobin, and blood albumin levels; and mean caloric intake were each significantly associated with successful ventilator withdrawal. The predictors of ventilator weaning in respiratory care center patients were identified as disease severity, rapid shallow breathing index, days of ventilator use, white blood cell level, and hemoglobin level. Conclusions / Implications for Practice: Respirator-dependent patients should be evaluated and monitored as early as possible. Moreover, a ventilator weaning plan should be included as a regular testing and monitoring item. Also, a respirator removal program should be provided on a case-by-case basis. Individualized ventilator weaning programs may reduce the burden on families and medical care providers.