消化道手術病人非預期重返加護病房原因分析

Causes for Unplanned Readmission to the Intensive Care Unit among Patients Receiving Intestinal Surgery

目的：分析消化道手術重症病人非預期重返加護病房在病人本身、加護病房轉出前及轉出後之成因。

材料與方法：研究收集南部某準醫學中心外科加護病房於2018至2019年接受消化道手術後入住外科加護病房重症病人之個人及住院過程相關資訊，進行統計分析。

結果：共收集545位病人，其中有42位發生非預期重返加護病房事件。轉出至普通病房後，格拉斯哥昏迷指數(Glasgow Coma Scale, GCS)≦14分、使用高流量氧氣設備、呼吸道清除功能失效、無法早期活動及無家屬陪病的病人有較高的比例發生非預期性重返事件。

結論：消化道手術重症病人轉出加護病房後，須注意意識、呼吸、活動狀態及家屬照護功能，有助於降低非預期重返加護病房的比例。

 

Objective: Analyzing causes for the unplanned readmission to the intensive care unit (ICU) in critically-ill patients receiving gastrointestinal surgery, and categorizing the causes into ones that lie in the patients themselves, events before being discharged from the ICU, and events after being discharged from the ICU.

Materials and Methods: The demographic and hospitalization-related data of patients in the surgical ICU of a medical center in southern Taiwan between 2018 and 2019 were collected for statistical analysis. The inclusion criterium was patients who were readmitted into the ICU after receiving gastrointestinal surgery.

Results: The data of 545 patients were collected. Among these patients, 42 experienced unplanned readmission to the ICU. After being transferred from the ICU into general wards, patients who had a Glasgow Coma Scale score of ≤ 14, required the use of high-flow oxygen devices, developed ineffective airway clearance, were incapable of early postoperative mobilization, and lacked family accompaniment were found to experience unplanned readmission to the ICU in a relatively higher percentage.

Conclusion: To reduce unplanned readmission to the ICU, after critically-ill patients receiving gastrointestinal surgery are transferred from ICUs to general wards, medical personnel shall pay attention to the patients’ consciousness, breath, mobility, and family accompaniment.