| Abstract: | 目的：探討中部某醫學中心加護病房造成非計畫性拔管之病患當時處置與照護人員之關係。材料與方法：本研究採事後病歷回溯法，依文獻查證後設計非計畫性拔管相關因素與「管路自拔滑脫意外事件收集表」為研究工具，自2003年1月1日至2005年6月30日止，研究對象為心臟加護病房、內科加護病房及外科加護病房留置氣管內管病患數共274人次，以SPSS/window10.0套裝軟體進行資料建檔及統計分析，進行t檢定、配對t和卡方檢定類別變項之相關性及差異分析。結果：發生非計畫性拔管與護理人員進階職級、上班時段無相關(P=0.515)。有、無重插兩組患者之意識狀態在拔管前活動(M; Motor)分數均較高，但未達顯著差異，但意識狀態於有重插時，其活動(M)(P<0.050)及睜眼反應＋活動(E+M; Eyes open + Motor)(P<0.047)項目分數有顯著差異，結果發現自拔管後無重插管者意識狀況較佳。結論：結果顯示自拔管後無重插管病患意識狀況較佳，因意識狀況或活動能力較好者，體能狀況也會較好，可清楚感受插管的不適，容易有自拔管的舉動，建議護理人員應加強評估並注意病患的需求，除了心理支持外，建議醫師適時給予鎮定藥物以減輕病患的不適，避免因自拔管而造成生命的威脅。另外，加護病房之醫療團隊在病患入院同時，就應有計畫性的替病患拔除氣管內管作準備，以免因延遲拔管造成病患痛苦的延長及醫療資源的浪費。
Purpose: The purpose of this study was to explore the factors influencing unintentional extubation in one medical center. Materials and Methods: In this retrospective study, we reviewed patient charts and collected data regarding the occurrence unintentional extubation in a cardiac intensive care unit, a medical intensive care unit, and surgical intensive care unit in one hospital in Central Taiwan from January 1, 2003 to June 30, 2005. Independent-samples t-test, paired-samples t-test, and Chi-Square were used to examine the differences between group variables. Statistical operations were performed SPSS PC Version 10.0. Results: We recruited a total 274 patients in whom unintentional extubations had occurred. Begin Most patients (72.3%) were 60 years old or older, male (70.8%), diagnosed with chest problems (34.3%), clear in consciousness (67.5%), not using sedatives, pain relievers, or muscle relaxants before unintentional extubation (74.5%), had both hands restrained (77.7%), and were slightly able to raise up and flex both hands once they were put on restraints (66.2%). For many (n=126, 46.2%), we were used A/C model on the respiratory assistive machine and many (n=167, 60.9%) were not re-intubated after the unintentional extubation Few had complications resulting from the reintubation (n=10, 3.6%). With regard to ward staffing, most nurses were N zero level nurses (38.8%), had one year nursing experience (n=87, 31.8%), were working the night shift (n=100, 36.5%), and were administering unrelated types of care when the extubation occurred (67.2%). Conclusion: This study found several causes of unintentional extubation. The injury and complication related to unintentional extubation not only increase medical costs and the duration of the hospitalization, but also increase the disease severity. Therefore, it is important to increase professional knowledge of care, emphasizing the possibility of several consequences of unintentional extubation. Emphasis should also be placed on patients' conscious level and continuous care. This can be done through continuing nursing education and patient education, and development of standard prevention measures to reduce unintentional extubation. |
