某醫學中心內科加護病房病人呼吸器脫離的相關因素之研究

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標題:	某醫學中心內科加護病房病人呼吸器脫離的相關因素之研究 Patient in the medical intensive care unit of a medical center ventilator weaning and the relevant factors
作者:	葉美華
貢獻者:	醫務管理系陳惠芳
關鍵字:	When a patient develops respiratory failure or difficulty, a respirator is used clinically to assist the patient in breathing to continue their life. The longer the respirator is used, the more it will increase the complexity of the condition and the risk of death. Therefore, assisting the patient to leave the respirator as soon as possible can reduce the damage caused by using the respirator. The respirator detachment program helps to improve the chance of getting out of the respirator and reduce the burden on the medical manpower. Therefore, this study aims to explore the factors related to the use of the respirator in the respirator to improve the clinical respiratory detachment success rate. The retrospective data of care is analyzed to assess and explore the current respirator detachment plan and serve as a reference for future care plan updates. This study used a retrospective approach to patients who underwent endotracheal intubation and respiratory therapy for respiratory failure during the period from August 1, 2014 to July 31, 2015 in a medical intensive care unit at a medical center in Central China. And analyze the medical records of the use of the respirator in the medical intensive care unit of the medical center during this period. After the merger, a total of 6,506 patient cases were excluded, and the respiratory care center (RCC) had patients who used the respirator, and will be calculated after returning home. The average of all parameters totaled 909 patients. Statistical analysis was performed with SPSS Window 19.0, including frequency, percentage, mean, standard deviation, Chi-square, and Multiple Logistic Regression Analysis. Explore the characteristics of the patient, the mechanical factors of the respirator, the spontaneous breathing index, and the physiological factors of the patient, and the relationship between whether or not to escape from the respirator. The study found that males were mostly (OR=0.356, P<.232), the total number of respirators used was 3-5 days (OR=0.462, P<.351), and the lower the inhaled oxygen fraction (OR=6.213, P< .044) The higher the rate of spontaneous detachment from the respirator for patients with spontaneous maximum inspiratory pressure ≧-30cmH2O (OR=2.472, P<.018). In addition, the lower the inhaled oxygen fraction (OR = 6.213), the total number of monitored respirations > 20 beats / min (OR = 2.472), and the arterial blood gas base excess value > + 2 (OR = 1.061)) There is a strong correlation with successful escape from the respirator. This study showed that the total number of days of sex and respirators used was 3-5 days, and the lower the inhaled oxygen fraction.The spontaneous maximum inspiratory pressure ≧-30cmH2O is a significant factor in the patient's respirator detachment.Clinical respiratory care can provide a place for respiratory therapists to pay attention to;the purpose of the study is to understand the factors related to ventilator detachment, to improve the success rate of clinical respirator detachment, and to develop a respiratory care assessment for future clinical detachment Project. 內科加護病房呼吸器脫離照護因素脫離指標 Intensive care unit Ventilator Weaning Care Factors Weaning profile
日期:	2019
上傳時間:	2020-12-09 14:43:14 (UTC+8)
摘要:	當病患產生呼吸衰竭或困難時，在臨床上會使用呼吸器輔助病人呼吸，以延續其生命。呼吸器使用的時間愈長，反而會增加病情的複雜度及死亡的風險。因此協助病人儘早脫離呼吸器，才能降低使用呼吸器所帶來的傷害。呼吸器脫離計畫有助於提高脫離呼吸器的成功機率，減少醫療人力的負擔，因此本研究旨在探討呼吸器使用患者呼吸器脫離之相關因素，藉以提升臨床呼吸器脫離成功率，對臨床照護的回溯性資料進行分析，以便對於現行呼吸器脫離計畫評估與探討，進而作為未來照護計畫更新的參考。本研究採用回溯式的研究法，以中部某醫學中心之內科加護病房，於2014年8月1日至2015年7月31日期間，因呼吸衰竭而接受氣管插管及使用呼吸器治療的病人，並分析該醫學中心內科加護病房此期間內使用呼吸器脫離成功之病歷資料，合併後共6,506病人次的病歷，排除呼吸照護中心(RCC)有使用呼吸器的病人，並將歸戶後計算所有參數之平均值總計為909位病人數。並以SPSS Window 19.0進行統計分析，包括頻率、百分比、平均數、標準差、卡方檢定（Chi- square）和多元羅吉斯回歸進行分析（Multiple Logistic Regression Analysis）。探討病人特性、呼吸器機械因素、自發性呼吸指標、及病人動脈氣體生理因素、對是否脫離呼吸器之影響。研究結果發現吸入氧氣分率<=60%（OR＝6.213，P＜.044）、自發性最大吸氣壓力≧-30cmH2O（OR＝2.472，P＜.018）的患者成功脫離呼吸器機率較高，達顯著影響。本研究顯示性別、呼吸器使用總天數為3-5天、吸入氧氣分率越低、自發性最大吸氣壓力≧-30cmH2O，和患者呼吸器脫離有相關。臨床呼吸照護是可以提供呼吸治療師著力注意的地方，本研究呼吸器脫離之相關因素結果，可提供提升臨床呼吸器脫離成功率，並據以研擬日後臨床脫離呼吸器之呼吸照護評估之項目。
關聯:	電子全文校內公開日期：2019-08-21;校外：2024-08-16 學年度：107，96頁
顯示於類別:	[醫務管理系(所)] 博碩士論文

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