心臟手術後患者呼吸器脫離影響因素與成功脫離之相關探討
中文摘要
本研究旨在探討心臟手術後患者呼吸器脫離影響因素與成功脫離時間之相關性，並找出最能有效預 測心臟術後病患成功脫離呼吸器的因素。以提供發展呼吸器脫離的護理措施，使病患能於手術後安 全及早期地脫離呼吸器，以減輕病患的焦慮及不舒適及降低醫療成本。
研究方法採探索性，橫斷面調查法。主要是以心臟手術後脫離呼吸器的評估指標進行資料收集。研 究場所為北部某醫學中心心臟外科加護病房，本研究共收集 121 位心臟手術後病患為研究對象，其 中有 115 人（ 95% ）於手術後成功脫離呼吸器。研究資料分析以百分比、平均值、標準差與排序 呈現描述性資料，再以 T-test 、 ANOVA 、 Chi-Square 、 Pearson correlation 、 Logistic regerssion 進行檢定。
研究結果發現：（一）手術後至開始脫離呼吸器的時間為 5.8 （ ±5.4 ）小時，術後呼吸器脫離所需 時間為 6.7 （ ±5.2 ）小時，而手術後至呼吸器脫離成功所需時間為 12.4 （ ±7.7 ）小時（二）術後 在準備脫離呼吸器前，神經學及肌力狀態評估為最不被滿足，以動脈血液氣體分析評估達成率最高，其中有六個評估項目為 50% 以上病患無法達到，包括「耳溫在 36~37.5℃ 」、「鎂離子 0.75~1.5 mmol/L 」、「意識清醒， Ramsay Scale 在 2~3 分」、「可舉起雙手或抬起腳離床 3~5 公分」、
「充分睡眠 / 休息」、和「無呼吸困難」（三）手術中使用的肌肉鬆弛劑（ pavulon ）劑量與術後 至開始脫離呼吸器所需的時間（ r=0.24 ， p=0.01 ）和手術後至呼吸器脫離成功所需的時間（ r=0.2 0 ， p=0.03 ）為顯著正相關；手術中有無使用心肺體外循環機對術後呼吸器使用的時間皆有所影響。
呼吸器脫離所需的時間則與「血液動力學評估」（ r= - 0.22 ， p=0.02 ）和「呼吸脫離指標評估」
（ r= - 0.23 ， p = 0.02 ）呈顯著負相關。（四）手術後開始脫離呼吸器四小時內成功脫離的預測變 項為手術中有無使用心肺體外循環機、呼吸脫離指標。在手術後八小時內可成功脫離呼吸器的預測 因素為手術中有無使用心肺體外循環機、血液氣體分析評估、體液電解質及臨床相關檢驗值。研究 結果可提供臨床醫護人員對於術後呼吸器脫離前的照護作參考。
關鍵字：呼吸器脫離、脫離指標The Relationship Between Related Factors of Ventilatory Weaning and the Successful Weaning in Patients Undergone Cardiac Surgery
英文摘要
The purpose of this research was to study the relationship between related factors of ventilatory weaning after cardiac surgery and successful weaning. To understand the most dissatisfied factors of weaning after cardiac surgery by using the weaning ind icators after cardiac surgery. In the mean time, we found out the most effective predictors of successful weaning after cardiac surgery. Thus we can provide and develop nursing intervention to improve ventilatory weaning after cardiac surgery.
An explored-correlated crossectional design was used. This research collected 121 cases of post-cardiac surgical patients and only 115 cases (95%) succeed in ventilatory weaning after cardiac surgery. Data was analyzed by percentage, mean, standard deviation, and frequency, T-test, ANOVA, Chi-Square, Pearson correlation, and Logistic regression.
The major findings of this study were as follows:(1)the time interval between post- surgery and the start of weaning is 5.8
（ ±5.4 ） hours, the time required for weaning was 6.7 （ ±5.2 ） hours, and the successful weaning time required was 12.4
（ ±7.7 ） hours. （ 2 ） The most dissatisfied factors of preparing weaning were patients’ neurological and musculoskeletal status. The best achieving factors was arterial blood gas. Over 50% of patients failed in 6 items, included 「 ear temperature i n 36~37.5℃ 」 , 「 magnesium level in 0.75~1.5 mmol/L 」 , 「 conscious clear ， Ramsay Scale about 2~3 scores 」 ,
「 hands elevat high and feet above the bed for 3-5 centimeters 」 , 「 sufficient sleep/ rest 」 and 「 no dyspnea 」 . （ 3 ） The dose of muscle relaxant （ pavulon ） used in operation was positive related to the time required from the post-operatio n till the start of weaning （ r=0.24 ， p=0.01 ） and also time required from post-operation till successful weaning （ r=0.20
， p=0.03 ） .Using cardiopulmonary bypass machine or not during cardiac operation makes difference on the time of ventila tor using after surgery. The weaning time required was significantly correlated to blood hemodynamic data （ r= - 0.22 ， p=
0.02 ） and the score of weaning protocol assessment （ r=- 0.23 ， p = 0.02 ）；（ 4 ） The significant predictors of succe ssful weaning in 4 hours after surgery were the usage of CPB machine or not and the weaning parameter. The significant predi ctors of successful weaning in 8 hours after surgery included the usage of CPB machine or not, the blood gas data, and the ele ctrolytes and clinical laboratory data 。 The result of this study would be valuable in quality of care of ventilatory weaning aft er surgery.
Key word ： ventilatory weaning, weaning indicators
