某醫院外科加護病房非計畫性拔除氣管內管之相關因素探討

目的：本研究目的在探討非計畫／計畫性拔除氣管內管兩組病患疾病狀況與呼吸氧合之差異性，及拔管後呼吸氧合與重插管之關係。方法：研究期間自2000年10月至2002年12月，以中部某醫學大學附設醫院外科加護病房非計畫及計畫性拔除氣管內管各60位病患為研究對象，依文獻查證後所設計之拔除氣管內管相關因素調查表為收集工具，採事後回溯法進行資料登錄。結果：本研究發現當病患處於呼吸器之呼吸模式設定為輔助／控制式時，非計畫性自拔管比率較高。呼吸氧合狀況較差的病患，包括使用吐氣末正壓大於5cmH2O、給氧濃度大於40%、動脈血氧與氧氣濃度比值小於200torr、脈衝式血氧飽和度小於等於95%，非計畫性自拔管及自拔管後重插管比率較高。結論：此結果顯示非計畫組病患病情穩定性較計畫組差，當病患插有氣管內管時，護理人員應密切觀察氧合狀態，以預防非計畫性拔除氣管內管的發生。
Purpose: This study identifies the different patient conditions and rate of oxygenation and searches for associations between oxygenation and re-intubation in patients undergoing planned and unplanned extubations (n=60) in a surgical intensive care unit in a medical center in Taiwan between October, 2000 and December, 2002. Methods: Data were collected with a questionnaire of our own design. Results: We found a higher rate of unplanned extubations among patients using ACMV mode with ventilator, PEEP>5cmH2O, FiO2>40%, PaO2/FiO2<200 and SpO2≦95%. The highest rates of re-intubation after self-extubation were in PEEP>5cmH2O, FiO2>40%, PaO2/FiO2<200 and SpO2≦95%. (p<0.05). Conclusion: The results of this study underscore the inherent instability of patients in the unplanned extubation group, indicating that nurses should be especially careful about monitoring oxygenation.