臺灣博碩士論文加值系統

國外已有許多研究證實，呼吸器脫離計畫（weaning protocol）不論在急性的內外科加護中心或亞急性的呼吸照護中心，皆可加速病患脫離呼吸器、減少呼吸器使用的時間及縮短住院天數，更可以降低醫療成本，但在國內這方面的臨床研究有限。本研究主要探討呼吸照護中心實施呼吸器脫離計畫對長期使用呼吸器病患使用呼吸器的天數、住院天數及呼吸器的脫離成功率的成效。
利用前瞻性世代研究與回溯性病歷調閱相對照之研究方法，比較某醫學中心呼吸照護中心（respiratory care center）實施呼吸器脫離計畫前（對照組）（2005年1月至3月）與實施後（實驗組）（2006年1月至3月），對長期使用呼吸器病患的呼吸器使用天數、住院天數及呼吸器脫離成功率的影響。
呼吸器脫離計畫實驗組病患130人，對照組病患111人。實施呼吸器脫離計畫後，實驗組平均呼吸器使用天數為15.17天（標準誤1.13，中位數9.5天），實施呼吸器脫離計畫前對照組之平均呼吸器使用天數17.40天（標準誤1.34，中位數12.5天），平均呼吸器使用天數之中位數減少3天(p=0.277)。實驗組的平均住院天數為16.09天（標準誤1.11，中位數10.5天），對照組平均住院天數18.63天（標準誤1.31，中位數14.0天），平均住院天數之中位數減少3.5天(p=0.204)。此外，實驗組與對照組的呼吸器脫離成功率分別為57.7％與47.7％(p=0.123)。以Cox迴歸分析，在控制其他相關因子後，實驗組較對照組成功脫離呼吸器的瞬間發生率(Hazard Rate)增加87.5％(p=0.001)。
綜言之，在呼吸照護中心實施呼吸器脫離計畫能增加長期使用呼吸器病患成功脫離呼吸器的機率；對使用呼吸器的天數、住院天數亦有助於減少，但未達顯著的統計差異。欲在臨床推廣，尚有許多技術細節待克服，其成效亦須大型研究證實。

It has been proved in the literature that weaning protocols, despite in acute or subacute care unit, help patients to wean from mechanical ventilation more rapidly, shorten the duration of ventilatory support and hospitalization, as well as reduce the medical cost. However, relevant, domestic studies are scanty. This study is to investigate the effect of a weaning protocol on the duration of mechanical ventilation, hospitalization, and successful weaning rate of patients with prolonged mechanical ventilation in a respiratory care center.
For comparison, the prospective cohort study and retrospective medical charts review were review were used. The weaning protocol was implemented in a respiratory care center from January to March 2006 as the study group, and medical charts review of those admission patients from January to March 2005 of the same respiratory care center as the control group.
There were 130 patients enrolled in the study group and 111 patients in the control group. The mean duration of mechanical ventilation were 15.17 days(standard error:1.13, median:9.5), and 17.40 days (standard error:1.34, median:12.5)(p=0.277) of the study group and the control group, respectively.The mean duration of hospitalization were 16.09 days (standard error:1.11, median:10.5) and 18.63 days (standard error:1.31, median:14.0) (p=0.204) of the study group and the control group, respectively.The successful weaning rate were 57.7% and 47.7% (p=0.123) of the study group and the control group, respectively. By Cox’proportional hazards analysis, the study group had a higher probability of weaning by 87.5% compared to the control group(p=0.001).
In Conclusion, the weaning protocol in respiratory care center on patients with prolonged mechanical ventilation may increase the probability of weaning. There were a trend to shorten the duration of mechanical ventilation and hospitalization There still have technical difficulties need to solved,and a large clinical trials need to be used to validate its effectiveness.

正文目錄
第一章 緒論 頁次
第一節 研究動機及重要性…………………………………………01
第二節 研究目的……………………………………………………03
第二章 文獻查證
第一節 呼吸器使用之相關概念……………………………………04
第二節 長期使用呼吸器之相關概念………………………………09
第三節 呼吸器脫離之相關概念……………………………………16
第四節 呼吸器脫離計畫及其成效之相關研究……………………30
第三章 研究架構與假設
第一節 研究架構……………………………………………………47
第二節 研究假設……………………………………………………48
第三節 名詞界定……………………………………………………48
第四章 研究方法
第一節 研究設計……………………………………………………50
第二節 研究場所與對象……………………………………………50
第三節 研究工具……………………………………………………51
第四節 研究過程……………………………………………………54
第五節 資料收集……………………………………………………55
第六節 資料分析……………………………………………………56
第七節 倫理考量……………………………………………………56
第五章 研究結果
第一節 研究對象人口屬性…………………………………………57
第二節 呼吸器脫離計畫對呼吸器脫離成效………………………60
第六章 討論
第一節 呼吸器脫離計畫對呼吸器使用天數、住院天數及脫離率之成效探討………………………………………………………65
第二節 各變項與是否成功脫離呼吸器之相關探討………………68
第七章 結論與建議
第一節 結論…………………………………………………………72
第二節 研究限制……………………………………………………72
第三節 應用與建議…………………………………………………73
第八章 參考文獻
英文文獻………………………………………………………………75
中文文獻………………………………………………………………88
附錄目錄
附錄一 呼吸器脫離計畫內容………………………………………91
附錄二 個案基本資料本……………………………………………93
附錄三 呼吸照護流程表……………………………………………94
附錄四 人體試驗計畫審議通過書…………………………………97
圖表目錄
圖一 研究架構………………………………………………………47
圖二 Kaplan-Meier 累積分布函數圖………………………………64

表一 個案基本資料表………………………………………………59
表二 實施呼吸器脫離計畫之結果…………………………………60
表三 以Cox迴歸分析探討各變項與呼吸器成功脫離所需時間之相關性……………………………………………………………61
表四 以Cox迴歸分析探討相關因子與呼吸器成功脫離所需時間之相關性…………………………………………………………63

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