本研究目的為探討非計畫性拔除氣管內管病患之相關因素及非計畫性與計畫性拔除氣管內管兩組病患間相關因素的差異性。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性拔除氣管內管之60位病患，及計畫性拔除氣管內管之508位病患中以立意取樣抽出60位病患為研究對象，以自擬之非計畫/計畫性拔除氣管內管相關因素調查表為資料收集工具，採事後回溯法依意外事件報告表、呼吸治療記錄及病歷進行資料登錄。研究結果在非計畫性拔除氣管內管組中發現：63.8%的病患自拔管時意識清醒、有61.7%的病患插管期間並未接受鎮靜劑、86.7%的病患接受約束時仍發生自拔管、有93.3%的自拔管發生在護理人員不在病患身邊時、35%自拔管發生在病患插管的第一天、而有88.3%的病患自拔管時仍使用呼吸器。在兩組相關因素差異性比較中發現：拔管前使用吐氣末正壓>5cmH2O、給氧濃度>40％、動脈血氧與氧濃度比值<200及脈衝式血氧飽和度≦95％，非計畫性自拔管比率及自拔管後重插管比率較高（Odds ratio：17.95、12.68、10.09、6.56; 7.55、4.49、4.50、20.1）。此結果顯示非計畫組病患病情穩定性較計畫組差，一旦發生自拔管時，應密切注意病患病情變化。
The purpose of this thesis is to explore the relative factors that influence the unplanned extubated patients, and differ the unplanned from the planned patients in their extubation of endotracheal tubes. This project selects sixty patients with unplanned extubation and sixty patients from five hundred eight patients with planned extubation in surgical intensive care unit at a medical center between October 2000 and December 2002. Applying the method of retrospectively review, I collect data through my devised questionnaire on factors related to unplanned/planned extubation of endotracheal tubes. The important findings in the unplanned extubation group are as follows: 63.8% patients at extubation were in clear conscious level, 61.7% patients didn’t take sedative in the course of intubation, 86.7% patients failed the restrain for self-extubation, 93.3% patients did their self-extubation while no nurse was at bedside, 35% self-extubation occurred on the first day of intubation, and 88.3% self-extubated patients were still in the need of mechanical ventilator. Concerning the differences between these two groups, the statistics above suggests the important factors related to unplanned/planned extubation group are: Unplanned extubation and re-intubations rate was higher when patients in PEEP>5cmH2O, FiO2>40%, PaO2/ FiO2<200torr and SpO2≦95%（Odds ratio：17.95、12.68、10.09、6.56; 7.55、4.49、4.50、20.1）.The result shows the unstable condition in the unplanned extubation group. In other words, after unplanned extubation occurs, nurse should pay close attention to monitor the condition and change of the patient.
