臺灣博碩士論文加值系統

背景:橫膈膜為呼吸運動最重要的肌肉，在呼吸器脫離過程中佔相當重要的角色，亦為評估之重要指標。以往的文獻指出傳統工具，最大吸氣壓 (maximal inspiratory pressure, MIP)及淺快呼吸指數(rapid shallow breath index, RSBI)並非良好的預測脫離機械通氣成功與否之因子，因此找出良好的預測因子是勢在必行的課題，介入非侵入性、風險低、且符合經濟效應的超音波測量橫膈膜厚度變化(Tickening Fraction,TF)作為預測因子，以減少呼吸器相關併發症，增加脫離機械通氣的成功率。
方法:以某醫學中心內科加護病房病患做前瞻性收案，於民國106年8月1日至11月30日止為期四個月，共收案50位，呼吸訓練第一天以超音波測量橫膈膜厚度變化。透過描述性統計、卡方檢定及獨立樣本t檢定來做資料分析，將所測量的厚度變化以軟體Prism繪出ROC(receiver operating characteristic curve)曲線，判別橫膈膜厚度是否為良好的預測因子。
結果:數據顯示成功組最大吸氣壓及淺快呼吸指數低於失敗組且具有顯著差異(P<0.05)；成功組橫膈膜厚度變化大於失敗組且具有顯著差異 (P<0.05)。最大吸氣壓<-20cmH2O作為切點的敏感度(sensitivity)為81%、特異度(specificity)為42%、陽性預測值(positive predictive value, PPV)為69%、陰性預測值(negative predictive value, NPV)為57%。淺快呼吸指數<105 breaths / min / L為切點的敏感度為97%、特異度為58%、陽性預測值為79%、陰性預測值為92%。TF>28%作為切點的敏感度為0.87、特異度為0.84、陽性預測值為0.9、陰性預測值為0.8。繪出的ROC曲線，曲線下的面積(Area Under Curve,AUC)分別為AUC(MIP)=0.7903、AUC(RSBI)=0.8871、AUC(TF)=0.9151。
結論:總結來說，呼吸訓練的過程中，以超音波測量橫膈膜厚度變化預測脫離機械通氣成功或失敗，為良好的預測工具。

Background: Diaphragm was the most important muscle for breathing exercise and played a very important role in the process of weaning ventilator. Previous literature indicated that the maximal inspiratory pressure (MIP) and rapid shallow breath index (RSBI) of traditional tools were not good predictors of weaning mechanical ventilation, and finding good predictors was an imperative issue. Used noninvasive, low-risk, and economically-effective of utrasound to measure tickening fraction (TF) could be a predictor to reduce ventilator complications and increased ratio of weaning success.
Methods: During the August 1-November 30, 2017 the 50 patients were collected, and underwent weaning trial. At first day of weaning trial to use ultrasound measured diaphragm thickness. Through descriptive statistics, Chi-square test, independent sample t test, and using Prism to report ROC (receiver operating characteristic) curve to determine whether the thickening fraction was a good predictor or not.
Results: The data showed MIP and RSBI was significantly lower in the successful group than in the failure group (P <0.05), and TF was significantly higher in the successful group than in the failure group (P <0.05). The cut point of MIP<-20, sensitivity was 0.81, specificity was 0.42, positive predictive value(PPV) was 0.69, negative predictive value(NPV) was 0.57, AUC(Area Under Curve) = 0.7903. RSBI<105, sensitivity was 0.97, specificity was 0.58, PPV was 0.79, NPV was 0.92, AUC = 0.8871. TF> 28%, sensitivity was 0.87, specificity was 0.84, PPV was 0.9, NPV was 0.8, AUC = 0.9151.
Conclusions: In summary, diaphragmatic thickening fraction during weaning trial was a good predictor for weaning success.

摘要 I
Abstract III
致謝 V
表目錄 VII
圖目錄 VIII
第一章 緒論 1
第一節 前言 1
第二節 研究目的 2
第三節 研究流程與步驟 3
第二章 文獻查證 4
第一節 呼吸運動 4
第二節 呼吸衰竭 5
第三節 脫離呼吸器的要素 7
第四節 如何脫離呼吸器 10
第三章 研究設計 15
第一節 研究對象 15
第二節 研究架構 16
第三節 研究實驗步驟 19
第四節 研究評估 20
第五節 資料分析方法 22
第四章 研究結果 23
第一節 樣本資料特性分析 23
第二節 成功組及失敗組差異性分析 23
第五章 討論 30
第六章 結論與限制 32
第一節 結論 32
第二節 研究限制 33
參考文獻 35
附錄一、IRB同意書 42
附錄二、IRB證明書 47

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