| Summary: | 碩士 === 輔英科技大學 === 護理系碩士班 === 107 === Gastrointestinal cancer is one of the most common cancers in the world. Patients who have undergone gastrointestinal cancer surgery often fail to breathe spontaneous after surgery, hence, resulting in ventilator-dependent complications and unable to dischage early. Thus, prolong the length of hospital stay and cause huge expenditures on health care. This retrospective study recruited 300 postoperative patients who were admitted to a teaching hospital in southern Taiwan from January 2015 to December 2018 for gastrointestinal cancer surgery, and transfer into the surgical intensive care unit to received postoperative respiratory support right after surgery. The patients were all over the age of 65. The data collected included demographic characteristics（age, gender）, health status（Charles comorbidity index, disease severity）, respirator detachment index（PiMax and RSBI）, and nutrition-related blood and biochemical tests. Descriptive statistics, independent t-test, bivariate correlation, multivariate linear regression, and MANOVA were conducted to examine the impact of nutritional status on ventilator dependency. The purpose of this study was to explore nutritional problems early after surgery and to identify predictive nutrition factors to help the target geriatric patients improve nutritional status early for successfully independent from ventilators.
The results showed that gastrointestinal cancer was the most common colorectal cancer, with a total of 266 people accounting for 88.7% of all subjects, and most of them were male, most of them between 75 and 84 years old, common in the third stage of cancer. Age (r=0.391, p < 0.001), disease severity assessment (r=0.728, p < 0.001) and the Charles comorbidity index (r=0.326, p < 0.001), RSBI (r=0.387, p < 0.001) were significantly positively correlated with the number of days of respirator use, indicating that the older the age, The higher the disease severity assessment score and the Charles comorbidity index, the lower the chance of successful ventilator detachment. Conversely, Transferrin (r=-0.120, p = 0.037), Prealbumin (only significant relationship on day 21 after surgery, r = -0.185, p = 0.001) was negatively correlated with the number of days of respirator use, ie, the higher the value In the lower case, the longer the respirator is used. The maximum inspiratory pressure is negative because of the negative correlation with the number of days of use of the respirator. The lower the Pimax (toward the normal state), the shorter the number of respirators used (r = -0.359, p < 0.001).
The general linear multivariate analysis (MANOVA) is used to analyze the multivariate synchronization of successful escaped respirator groups and failed groups, and Pillai's tracking statistical verification is based on this general linear multivariate analysis model. The modified model is presented, RSBI (Adjusted R2= 54.9%) and Pimax (Adjusted R2=51.9%) best explain the probability of successful escape from the respirator. Nutritional factors Transferrin (Adjusted R2=34.5%) and Prealbumin (Adjusted R2=10.4%) are also important predictors and can guide Clinical nutritional intervention and accelerated recovery of patients are valuable discussions. However, clinically, it is mainly used to assess the nutritional status of patients and the indicators for opening nutrient infusions. There is no statistical support for the relationship between the number of days of respirator use and the number of days of respirator use.
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