心臟手術患者早期拔除氣管內插管之改善方案

The Effect of Early Extubation Programs on Cardiac Surgical Patients

近年來心臟手術的需求增加並耗費醫療資源,而加護中心住院天數、術後合併症及住院總天數是造成心臟手術患者成本增加的原因,術後機械性呼吸輔助器使用天數直接影響加護中心住院天數。本專案旨在縮短心臟手術患者氣管內插管的留置時間藉以減少加護中心住院天數,自民國89年2月1日至89年12月31日止在分析現況後依問題擬訂心臟手術患者早期拔除氣管內插管流程圖、製訂麻醉及手術技術的標準及提供醫護人員有關早期拔除氣管內插管的在職教育等方案,經8個月的執行,結果為:氣管內插管留置時間由專案前的49小時縮短為11.4小時,有61%的心臟手術患者於術後12小時內拔除氣管內插管,加護中心住院天數縮短1.3天,住院總天數縮短4天,重插管率及住院30天死亡率為零。住院醫療費用每人約減少7萬元。

The increasing use of cardiac surgery has a significant impact on the ever-limited resources in the health care system. Cardiac surgery consumes more health care resources than any other single procedure. Intensive care units hospital lengths of stay, and postoperative complications are the significant predictors of cost for cardiac surgical patients. Prolonged ventilation was related to longer ICU stay.The purpose of this program was to extubate early for the cardiac surgical patients. After analyzing the process, the team standardizied the new practices as follows: (1)early extubation algorithm; (2)anesthesia and operation protocol; (3)providing education program for nurses and doctors. The results indicated the mean time from operative room to extubation was 11.4 hours, 61% of the 100 patients were extubated successfully within 12 hours, with resultant decreases of ICU and hospital lengths of stay as well as costs. The incidence of reintubation and inhospital mortality was zero.