呼吸器脫離評估項目與呼吸器脫離結果之相關性探討

呼吸器脫離評估項目與呼吸器脫離結果之相關性探討

 中文摘要

 本研究旨在探討呼吸器脫離評估項目與呼吸器脫離結果之相關性。期望藉由這些評估項目瞭解病患 在準備呼吸器脫離前的得分狀態，並決定呼吸器脫離評估項目得分與脫離呼吸器結果之相關性，並 找出最能預測呼吸器使用超過三天以上病患，成功脫離呼吸器的預測因素，以作為發展呼吸器脫離 護理措施之依據，使病患能及早脫離呼吸器，並減輕病患的焦慮及不適、家屬的擔心、害怕，並達 到縮短住院天數、降低醫療成本之成效。

 本研究採探索性研究法，主要是以 27 項六大類評估項目作為呼吸器脫離相關因素探討之評估指引

，以進行資料收集。研究場所為中部某醫學中心之一般內科加護病房，共收案 70 位呼吸器使用超 過三天之病患為研究對象，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-tes t 、 Chi-Square 、 Pearson correlation 、 logistic regression 進行檢定。

 研究結果發現： ( 一 ) 成功脫離呼吸器病患在呼吸器脫離訓練前其身

 心評估後的整體準備度為 71% ；六大評估項目中，以心理評估方面的達

 成率最高，臨床相關檢驗評估項目則是最低。 27 項脫離前評估項目的達

 成率最低的前五項依序為「呼吸音正常」、「 Albumin 3.5gm/dl≧ 」、「自發性潮氣容積 >5ml/k g 」、「快淺呼吸指標 <105/bpm/L 」及「血中鈣離子介於 8.5-10mg/dl 、血中鎂離子介於 1.7-2.1mg /dl 、血中磷離子介於 2.5-5.5 mg/dl 」。 ( 二 ) 基本屬性、六大類評估項目、 27 項評估項目達成率 和脫離前呼吸器使用時間皆與呼吸器脫離花費時間無顯著相關。 ( 三 ) 年齡（ r=-0.38, p<.01 ）、疾 病嚴重度（ r=-0.34, p<.01 ）和呼吸器脫離結果呈顯著負相關， 27 項評估項目達成率（ r=-0.62, p<.

01) ；六大評估項目中之呼吸脫離指標評估（ r=0.42,p<.01 ）、血液氣體分析評估（ r=0.28, p=0.0 2 ）、心理評估項目（ r=0.63, p<.01 ）與脫離結果呈顯著正相關；呼吸器脫離前呼吸器使用時間

（ r=-0.27, p=.02 ）則與呼吸器脫離結果呈顯著負相關。 ( 四 ) 呼吸器脫離成功的預測變項為，心理 評估方面、年齡、臨床相關檢驗、脫離指標，其總解釋量為 61% 。

 研究結果可提供臨床醫護人員針對於呼吸器使用病患於脫離訓練前之照護參考。

Correlations Between Ventilator Assessment Items and Ventilator Weaning Outcome

 英文摘要



The purpose of this research was to study correlations between ventilator assessment items and venti lator weaning outcome. To understand the achieving rate before ventilator weaning, and found out t he most effective predictors of ventilator weaning outcome after using the ventilator over 3 days.

An explored and correlated design was used. A total of 70 cases that met the selection criteria were re cruited in the study. Data were analyzed by percentage, mean, standard deviation, frequency, t-test, Chi-Square, Pearson correlation, and logistic regression.

The major findings of this study were as follows: (1) In the successful weaning group, the totally achi eving rate was 71%. The best achieving category among the six assessment categories was the psycho logical category. The lowest achieving category was the category of clinical laboratory data. The first five lowest achieving items were 「 normal breathing sound 」 , 「 Albumin 3.5 gm/dl

ntaneous tidal volume>5ml/kg 」 , 「 rapid shallow breath index<105/bpm/L 」 , 「 calcium level i n 8.5-10mg/dl 」 , 「 magnesium level in 1.7 - 2.1mg/dl 」 , and 「 phosphorous level in 2.5-5.5 mg/d l 」 . (2) Demographic characteristics, six assessment categories, the achieving rate of twenty-seven a ssessment items, and the time of ventilator using before weaning were not significantly correlated to t he ventilator weaning outcome. (3) Age （ r=-0.38, p<.01 ） and APRCHE II （ r=-0.34, p<.01 ） we re significantly correlated to ventilator weaning outcome. The achieving rate of twenty-seven assessm ent items （ r=-0.62, p<.01 ） , weaning profile （ r=0.42, p<.01 ） , arterial blood gas analysis （ r

=0.28, p=.02 ） , psychological category （ r=0.63, p<.01 ） were positive related to ventilator weanin g outcome. The time of ventilator using before ventilator weaning （ r=-0.27, p=.02 ） was negative c orrelated to ventilator weaning outcome. (4) The significant predictors of successful weaning include d psychological category, age, clinical laboratory data, and blood gas data, the result of indicated of 6 1% variances.

The results of this study would be valuable in improvement of care quality of ventilator weaning.