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研究生:鄭鳳惠
研究生(外文):JHENG,FENG-HUI
論文名稱:探討重症高齡病人計畫性拔管概況及住院存活之預測分析
論文名稱(外文):The Exploration of Planned Extubation and Predication Analysis of Hospital Survival in Elderly Patients
指導教授:鄭瑞棠 
指導教授(外文):CHENG,JUEI-TANG
口試委員:陳欽明鄭愛琴
口試委員(外文):CHEN,CHIN-MINGCheng,AI-CHIN
口試日期:2020-07-21
學位類別:碩士
校院名稱:長榮大學
系所名稱:醫學研究所
學門:醫藥衛生學門
學類:醫學學類
論文種類:學術論文
論文出版年:2020
畢業學年度:108
語文別:中文
論文頁數:84
中文關鍵詞:高齡計畫性拔管呼吸器脫離預測
外文關鍵詞:elderlyplanned extubationventilation weaningpredication
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老年人肺炎的預防佔據健保醫療成本相當高之花費且其死亡率亦持續蟬聯十大死因中前三名,隨著現今就醫的便利普及,使得老年病人在罹患呼吸疾病時,能予即時性插管治療,以穩定生命,伴隨著疾病的控制改善,老年人脫離機械性呼吸器成為臨床上相當大的挑戰。根據中央健康保險署(2019年)統計資料顯示,106年新增175,148人需依賴呼吸器維生,可見臨床脫離之困難度,文獻提出重症加護單位拔管失敗的病人會有較高的住院死亡率,在歐美三家醫學中心的世代研究報告亦指出,使用呼吸器病人的住院死亡率是26%至34%,因此引發筆者想進一步深入進行討論。
本研究為觀察性病例研究,以南部某醫學中心為例,蒐集2010/01/01~2017/12/31期間重症加護單位的高齡病人因肺炎致呼吸衰竭使用呼吸器之臨床資料,作為住院存活與死亡預測,共收集114位高齡計畫性拔管病人,存活組為81人,死亡組為33人。使用SPSS Window 18版統計軟體進行統計分析,發現影響住院死亡之因素有血紅素及尿素氮等檢驗值參數,統計上有顯著差異(p<0.05),進一步分析發現:插管後第三天內開始計畫脫離及困難脫離的住院存活機率高;反之,延遲脫離、呼吸器使用總時數、拔管失敗及加護病房天數等預測因子的住院死亡率較高。

最終預期此研究貢獻能增進高齡病人之臨床照護成效、減少醫療成本耗費,並將其結果作為臨床照護之參考依據,同時避免醫療資源浪費及提升高齡病人照護品質。

The prevention of pneumonia in the elderly occupies a very high cost of health care and its death rate continues to rank among the top three causes of death. With the convenience of medical treatment today, the elderly patients can be inserted immediately when they suffer from respiratory diseases. In order to stabilize life, with the improvement of disease control, the elderly get rid of mechanical ventilators has become a clinically significant challenge. According to the statistics of the Central Health Insurance Agency (2019), the newly added 175,148 people in 106 need to rely on ventilators to survive, which shows the difficulty of clinical detachment. According to the literature, patients who fail to extubate in intensive care units will have higher hospitalizations mortality, the generational research reports of three medical centers in Europe and the United States pointed out that the in-hospital mortality rate of patients using ventilators is 26% to 34%, so the author wants to discuss it further.
This study is an observational case study, taking a southern medical center as an example, collecting clinical data on the use of ventilators for respiratory failure caused by pneumonia in elderly patients in the intensive care unit from 2010/01/01 to 2017/12/31, as hospital survival. With the death prediction, a total of 114 elderly planned extubation patients were collected, with 81 in the survival group and 33 in the death group. Statistical analysis was performed using SPSS Window version 18 statistical software, and it was found that the factors that affected hospitalization death included hemoglobin and blood urea nitrogen and so on, and there were statistically significant differences (p<0.05). Further analysis found that: the survival rate of these started wean within the third day after intubation or difficult weaning group is high; on the contrary, the mortality rate with predictors such as delayed weaning, total ventilator hours, extubation failure and intensive care unit length is high.
Eventually, this research contribution is expected to enhance the effectiveness of clinical care for elderly patients, reduce medical costs, and use the results as a reference for clinical care, while avoiding waste of medical resources and improving the quality of care for elderly patients.


目 錄
頁次
致謝………………………………………………………..…Ⅰ
目錄………………………………………………………..…Ⅱ
英文縮寫……………………………………………………..Ⅳ
中文摘要……………………………………………………..Ⅴ
英文摘要……………………………………………………..Ⅶ
壹、導論…………………………………………………..…..1
一、文獻查證…………………………………………………...2
第一節 氣管內管插管之相關概念
第二節 呼吸器使用原因
第三節 呼吸器脫離與拔管之相關因素
第四節 影響呼吸器脫離之相關因素
貳、研究構想………………………………………………………16
參、研究材料與方法……………………………………….17
第一節 研究架構……………………………………………...17
第二節 研究對象及時間……………………………………….18
第三節 資料蒐集………………………………………….. ….19
第四節 倫理考量……………………………………………...22
第五節 統計分析……………………………………………...23
肆、結果與討論…………………………………………….24
伍、結論及建議…………………………………………….41
陸、參考文獻……………………………………………….44
一、中文參考文獻
二、英文參考文獻
柒、附錄
一、附錄一、人體試驗委員會研究核准函
表目錄
頁次……………………………………………………………53
表一 高齡肺炎病人之呼吸器計畫性拔管的基本特性…………….53
表二 高齡肺炎病人之呼吸器計畫性拔管的營養狀況…………….54
表三 高齡肺炎病人之呼吸器計畫性拔管的共病史之分析………..55
表四 高齡肺炎病人之呼吸器計畫性拔管的拔管前臨床測量數據…56
表五、高齡肺炎病人之呼吸器計畫性拔管的拔管前的生命徵象與動脈血液值……57
表六、高齡肺炎病人之呼吸器計畫性拔管的脫離指標參數………58
表七、高齡肺炎病人之呼吸器計畫性拔管的脫離情形……………59
表八、高齡肺炎病人之呼吸器計畫性拔管的預後…………….. …60
表九 住院存活組與住院死亡組之基本特性比較…… ……………61
表十 住院存活組與住院死亡組共病症比較………………………62
表十一 住院存活組與住院死亡組營養狀況比較………………….63
表十二 住院存活組與住院死亡組臨床測量數據比較……………..64
表十三 住院存活組與住院死亡組拔管前生命徵象與動脈血液值比較……………………………………………………………………………………………….65
表十四 住院存活組與住院死亡組脫離指標參數比較…………………..66
表十五 住院存活組與住院死亡組脫離狀態比較………………………….67
表十六 住院存活組與住院死亡組預後之比較……………………………..68
表十七 住院死亡的預測因子…………………………………………………….69
圖 目錄 頁碼
圖一 研究者之收案流程……………………………….………..70
圖二 Acute weaning and extubation protocol…………71
附錄 共病史之定義…………………………………………......72




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