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題名：呼吸衰竭病人延遲脫離的影響因子初探
書刊名：醫務管理期刊
作者：王娜娜／陳宏一／鄭愛琴／紀宗呈 引用關係／陳欽明／紀宗利
作者(外文)：Wang, Na-na／Chen, Hong-i／Cheng, Ai-chin／Chi, Tzong-cherng／Chen, Chin-ming／Chi, Tzong-li
出版日期：2015
卷期：16:3
頁次：頁205-221
主題關鍵詞：機械通氣；延遲脫離；加護病房；住院期間死亡率；Mechanical ventilation；Prolonged weaning；Intensive care unit；In-hospital mortality
原始連結：連回原系統網址new window
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  • 被引用次數被引用次數:期刊(0) 博士論文(0) 專書(0) 專書論文(0)
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  • 共同引用共同引用:2
  • 點閱點閱:28
目的：延遲脫離影響著病人住院期間的死亡率及拔管成功率，本研究主在探討延遲脫離的影響因子，期待結果能幫助照護團隊瞭解並改善延遲脫離的發生。方法：回溯性研究，收集台灣南部某教學醫院於加護病房使用機械通氣經專責醫師評估病況穩定且執行計劃性拔管後120小時未再插管之臨床病資。以SPSS 18.0進行統計分析，定義統計顯著為p＜0.05。結果：簡單、困難、延遲脫離各組的累計發生個數（率）分別為745（49.4%）、508（33.7%）及255（16.9%）。有較高比例的延遲脫離病例插管原因在肺炎；呼吸衰竭種類屬肺部呼吸道系統者。結論：多因素logistic regression model分析顯示：插管天數長、呼吸衰竭種類為肺部呼吸道系統及因換氣不足插管者，延遲脫離的勝算高。
Objectives: Prolonged weaning affects mortality and the extubation success rate during hospitalization. The aim of the present study was to discuss the factors impacting prolonged weaning of respiratory failure patients. The research results are expected to help medical care teams understand and improve the incidence of prolonged weaning. Methods: This was a retrospective study. The medical records data were collected from a regional teaching hospital in southern Taiwan. The patients were admitted to the intensive care unit, intubated, and mechanical ventilation was initiated. When a patient was stable based on attending physician assessment, planned extubation was performed for at least 120 h without re-intubation. Statistical analyses were conducted on the data using SPSS 18.0. The level of significance was set at 0.05. Results: The cumulative incidences of the simple, difficult, and prolonged weaning groups were 49.4%, 33.7%, and 16.9%, respectively. A higher proportion of patients with prolonged weaning were intubated for pneumonia and pulmonary respiratory failure types. Conclusions: Based on a multivariate logistic regression model analysis, intubation days, pulmonary respiratory failure types, and intubation due to hyperventilation had a greater odds of prolonged weaning.
期刊論文
1.Boles, J. M.、Bion, J.、Connors, A.、Herridge, M.、Marsh, B.、Melot, C.、Welte, T.(2007)。Weaning from mechanical ventilation。The European Respiratory Journal，29(5)，1033-1056。  new window
2.李靜怡、陳玉如、翁敏雪、林晏如、陳健文(20080000)。呼吸器對橫膈膜的影響。中華民國重症醫學雜誌，9(3)，191-197。  延伸查詢new window
3.陳菀琪、葉莉莉(20011000)。制約理論於呼吸器延遲脫離患者之應用。醫護科技學刊，3(4)，365-374。new window  延伸查詢new window
4.Cook, D.、Meade, M.、Guyatt, G.、Butler, R.、Aldawood, A.、Epstein, S.(2001)。Trials of miscellaneous interventions to wean from mechanical ventilation。Chest，120(6)，438-444。  new window
5.Epstein, C. D.、Peerless, J. R.(2006)。Weaning readiness and fluid balance in older critically ill surgical patients。American Journal of Critical Care，15，54-64。  new window
6.Epstein, S. K.(2009)。Weaning from ventilatory support。Current Opinion in Critical Care，15(1)，36-43。  new window
7.Funk, G. C.、Anders, S.、Breyer, M. K.、Burghuber, O. C.、Edelmann, G.、Heindl, W.、Hartl, S.(2009)。Incidence and outcome of weaning from mechanical ventilation according to new categories。European Respiratory Journal，35(1)，88-94。  new window
8.Kulkarni, A. P.、Agarwal, V.(2008)。Extubation failure in intensive care unit: Predictors and management。Indian Journal of Critical Care Medicine，12(1)，1-9。  new window
9.Langer, M.、Mosconi, P.、Cigada, M.、Mandelli, M.(1989)。Long-term respiratory support and risk of pneumonia in critically ill patients。American Review of Respiratory Disease，140(2)，302-305。  new window
10.Cavallone, L. F.、Vannucci, A.(2013)。Extubation of the difficult airway and extubation failure。Anesthesia and Analgesia，116(2)，368-383。  new window
11.Newth, C. J. L.、Venkataraman, S.、Willson, D. F.、Meert, K. L.、Harrison, R.、Dean, J. M.、Nicholson, C. E.(2009)。Weaning and extubation readiness in pediatric patients。Pediatric Critical Care Medicine，10(1)，1-11。  new window
12.Peñuelas, O.、Frutos-Vivar, F.、Fernández, C.、Anzueto, A.、Epstein, S. K.、Apezteguía, C.、Esteban, A.(2011)。Characteristics and outcomes of ventilated patients according to time to liberation from mechanical ventilation。American Journal of Respiratory and Critical Care Medicine，184(4)，430-437。  new window
13.Scalise, P. J.、Vottol, J. J.(2005)。Weaning from long-term mechanical ventilation。Chronic Respiratory Disease，2(2)，99-103。  new window
14.Sellares, J.、Ferrer, M.、Cano, E.、Loureiro, H.、Valencia, M.、Torres, A.(2011)。Predictors of prolonged weaning and survival during ventilator weaning in a respiratory ICU。Intensive Care Medicine，37(5)，775-784。  new window
15.Seymour, C.、Martinez, A.、Christie, J.、Fuchs, B.(2004)。The outcome of extubation failure in a community hospital intensive care unit: a cohort study。Critical Care，8(5)，1-6。  new window
16.Su, J.、Lin, C. Y.、Chen, P. J.、Lin, F. J.、Chen, S. K.、Kuo, H. T.(2006)。Experience with a step-down respiratory care center at a tertiary referral medical center in Taiwan。Journal of Critical Care，21(2)，156-161。  new window
17.Tonnelier, A.、Tonnelier, J. M.、Nowak, E.、Gut-Gobert, C.、Prat, G.、Renault, A.、L'Her, E.(2011)。Clinical relevance of classification according to weaning difficulty。Respiratory Care，56(5)，583-590。  new window
18.Weilitz, P.(1993)。Weaning a patient from mechanical ventilation。Critical Care Nurse，13(4)，33-40。  new window
19.Wu, Y. K.、Kao, K. C.、Hsu, K. H.、Hsieh, M. J.、Tsai, Y. H.(2009)。Predictors of successful weaning from prolonged mechanical ventilation in Taiwan。Respiratory Medicine，103(8)，1189-1195。  new window
20.宰翡霙、何釐瑗、王桂芸(20071100)。計畫性拔管失敗之衝擊及其臨床處置。源遠護理，1(3)，5-14。  延伸查詢new window
21.American Association for Respiratory Care(2007)。Removal of the endotracheal tube - 2007 revision & update。Respiratory Care Journal，52，81-93。  new window
研究報告
1.行政院衛生署中央健康保險局(2011)。全民健康保險統計資料。台灣：行政院衛生署中央健康保險局。  延伸查詢new window
學位論文
1.黃惠珠(2004)。呼吸治療專業品質之探討--臨床相關因素對呼吸器脫離的影響(碩士論文)。國立中山大學。  延伸查詢new window
圖書
1.Emblemsvåg, J.(2012)。Risk Management for the Future - Theory and Cases。Croatia, Rijeka：InTech。  new window
2.Improta, G.、Fratini, A.、Triassi, M.(2012)。Health technology assessment: An essential approach to guide clinical governance choices on risk management。InTech Open Access Publisher。  new window
 
 
 
 
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