| Abstract: | 背景：本研究的目的為，探討中部地區某醫學中心呼吸照護中心(Respiratory care center，RCC)延遲機械通氣(呼吸器使用≧21天)的成年患者，成功脫離呼吸器的預測因子。方法：藉由回溯2016年1月至2017年12月，共342案例。依人口統計學項目，敘述各項特徵。再以單因素分析釐清各相關因素，最後以羅吉斯向後迴歸分析方式，逐步移除非顯著因素確立預測因子。結果：依病人呼吸器脫離狀態分為成功與失敗兩組。227例成功脫離呼吸器，脫離成功率為66.4%。呼吸器脫離失敗的病人有較高的急性生理學和慢性健康評估II(APACHE II)評分、較長的RCC住院天數、格拉斯哥昏迷量表評分較低及每分鐘通氣量較高。與呼吸器脫離相關的因素是血清白蛋白、血紅素、血清前白蛋白、APACHE II、格拉斯哥昏迷指數、RCC住院天數和每分鐘通氣量等，共七項。羅吉斯向後法迴歸分析顯示，呼吸器脫離失敗預測因子為低血清白蛋白(OR=0.4，p=0.006)、高APACHE II分數(OR=1.1，p=0.009)、RCC住院天數長(OR=1.2，p=0.000)及每分鐘通氣量高(OR=1.1，p=0.006)。結論：RCC環境不同於ICU的照護，病人成功脫離呼吸器的比率較高。與呼吸器脫離相關的預測因素包括血清白蛋白、APACHE II分數、RCC住院天數及每分鐘通氣量。
BACKGROUND：The purpose of this study was to explore the predictive factors of successfully removed from the ventilator of delayed mechanical ventilation (respiratory device using ≧ for 21 days) of an adult patient who is in the respiratory care center (RCC) in a medical center of the central Taiwan.METHODS：This was a retrospective observational study performed in an RCC. A total of 342 patients were transferred to RCC because of prolonged mechanical ventilation between January 2016 and December 2017. The demographics, clinical characteristics, and laboratory data were compared. Univariate analysis was performed to determine factors associated with prolonged mechanical ventilation, and logistic backward regression analysis identified the predictors associated with difficulties in weaning patients from mechanical ventilation.RESULTS：According to mechanical ventilation weaning status, patients were divided into two groups of weaning successful and weaning failure. As a result, a total of 227 patients were successfully weaned from the mechanical ventilation, and the successful weaned rate was 66.4%. In the group of unsuccessful weaning, the following were significantly lower GCS scores (P =0.017), serum albumin(p=0.000), Hemoglobin(p=0.004), and lower serum prealbumin (p=0.002) compared to successfully weaned group. The following were all significantly higher in the unsuccessfully weaned group: APACHE II scores(p=0.000), length of RCC length of stay(p =0.000), and minute ventilation (p =0.046).Logistic backward regression analysis showed that the predictors of ventilator weaned failure were lower serum albumin (OR=0.4, p=0.006), higher APACHE II score (OR=1.1, p=0.009), and length of RCC length of stay (OR=1.2, p=0.000) and higher minute ventilation (OR=1.1, p=0.006).CONCLUSION：High rates of ventilator independence can be achieved in an RCC setting as an alternative to ICU care. Predictors associated with ventilator weaning includes serum albumin, APACHE II score, RCC length of stay, and minute ventilation. |
