臺灣博碩士論文加值系統

背景：術後譫妄是開心手術後常見合併症之一，可能在手術後24-72小時出現，造成急性認知功能障礙；而衰弱則是慢性症候群，導致生理功能的喪失，兩者皆對開心手術患者產生負面影響，但衰弱與術後譫妄的相關性仍未有定論。
目的：探討衰弱與術後譫妄的相關性，並分析術後譫妄的預測因子。
方法：採描述性相關性研究，以立意取樣方式收案152位年齡 ≥ 20歲以上，行常規開心手術患者，以衰弱量表評估患者術前衰弱情形，在術後第一天到第五天以加護病房混亂評估量表評估譫妄，以了解患者術後譫妄發生率，並分析影響術後譫妄的預測因子。資料分析包括平均值、標準差、百分比、t-test、Mann-Whitney test、χ2 test、Fisher exact test以及邏輯斯迴歸等統計方法。
結果：在152位開心手術患者中，手術前共有68位(44.74%)為衰弱前期患者，21位(13.81%)為衰弱患者。患者在開心手術後發生譫妄比率為6.58%，共有10位，發生譫妄時間在術後第二天、第三天為高峰期，平均持續時間為兩天；以簡單邏輯斯迴歸分析時，發現術前衰弱與術後譫妄無顯著相關，但進一步進行病例對照分析時，發現術前衰弱與術後譫妄具有顯著相關性；開心手術患者術後譫妄的顯著預測因子包括歐洲心臟手術風險評估系統II、術前心律不整、術前焦慮及憂鬱；再者，將患者分為有無術前衰弱兩組進行分析，有衰弱組中，術前心律不整是引發術後譫妄的預測因子，而在無衰弱組，則是術前憂鬱為重要預測因子。
結論：本研究發現術前衰弱與術後譫妄有顯著相關性，透過結果可以了解術後譫妄的相關因素及預測因子，做為臨床護理人員的照護依據，希冀未來可以應用於改善衰弱與術後譫妄之現象。
關鍵字：心臟手術、衰弱、譫妄

Background: Postoperative delirium is a common complication in patients post cardiac surgery. It might occur in 24-72 hours after surgery and lead to acute cognitive dysfunction. Frailty is a chronic syndrome. Both of them have a harmful impact on patients. The association between frailty and delirium has not been satisfactorily explored.
Aim: The aim of this study is to explore the relationship between frailty and postoperative delirium in cardiac surgery patients. Then to find out which are risk factors for postoperative delirium.
Methods: This is a prospective correlational study. One hundred fifty two cardiac surgery patients aged ≥ 20 years and prepared for elective surgery were recruited. Data were collected using the Fried criteria and CAM-ICU to assess frailty and delirium from the first to fifth day after surgery to find out the incidence and predictors of delirium. Statistical methods included mean (standard deviation) or median (range), frequencies (n) and percentange (%), t test, Mann-Whitney test, χ 2 tests, Fisher exact test and logistic regression. All tests were two-tailed, and the p-value of < 0.05 was regarded as statistically significant.
Result: Among152 eligible patients, 68(44.74%) patients are pre-frail and 21(13.81%) are frail. The incidence of the postoperative delirium was 6.58%, and the first episode of delirium occurred on the second or third postoperation day. In the study, delirium lasted for two days. When using logistic regression that frailty is no significant association with delirium. Using case-control study, frailty is a significantly associated with delirium. The study found out the significant predictors for postoperative delirium included EuroSCORE II, pre-operation arrhythmia and depression or anxiety before surgery. In frail patients, a pre-operation arrhythmia is a significant predictor for delirium. In no frail patients, depression before surgery is a significant predictor.
Conclusion: The study found out that frailty and postoperative delirium highly associated. To understand what the risk factors and predictors are for postoperative delirium would be a benefit for health care providers to improve both frailty and postoperative delirium for cardiac surgery patients.
Keywords: cardiac surgery, frailty, postoperative delirium

誌謝 i
中文摘要 ii
英文摘要 iv
目錄 vi
表目錄 viii
圖目錄 ix
第一章 緒論 1
第一節 研究背景與動機 1
第二節 研究目的 5
第二章 文獻查證 6
第一節 開心手術與常見合併症介紹 6
第二節 手術後譫妄及其相關因素 13
第三節 開心手術患者的衰弱情形及其與譫妄之相關性 31
第三章 研究方法 42
第一節 研究設計 42
第二節 研究架構 43
第三節 名詞界定 44
第四節 研究問題 45
第五節 研究對象與場所 46
第六節 研究工具 47
第七節 資料收集過程 55
第八節 資料處理與分析 58
第九節 研究倫理考量 59
第四章 研究結果 60
第一節 研究對象基本屬性 60
第二節 開心手術患者術前衰弱的盛行率 70
第三節 開心手術患者術後譫妄的發生率與持續時間 73
第四節 開心手術患者術前衰弱與術後譫妄的相關性 75
第五節 影響開心手術患者術後譫妄的預測因子 77
第五章 討論 88
第一節 開心手術患者術前衰弱盛行率與術後譫妄的發生率 88
第二節 術前衰弱與術後譫妄的相關性 90
第三節 影響術後譫妄的相關因素和預測因子 92
第六章 結論與建議 101
第一節 研究結論 101
第二節 護理應用 102
第三節 研究限制與建議 105
參考文獻 107
附錄 122
表2-2-1常見譫妄評估量表 30
表3-6-1本研究衰弱指標判定陽性之標準 50
表3-8-1推論性統計方法 58
表4-1-1研究對象基本屬性(N = 152) 62
表4-1-2研究對象疾病特性(N = 152) 67
表4-2-1開心手術患者術前衰弱情形(N = 152) 72
表4-3-1術後五天內的譫妄發生率與持續時間(N = 152) 74
表4-4-1術前衰弱與術後譫妄的相關性(N = 152) 75
表4-4-2術前衰弱與術後譫妄之相關性－簡單邏輯斯迴歸之結果 76
表4-5-1前置因素與術後譫妄的相關性(N = 152) 78
表4-5-2誘發因素與術後譫妄的相關性(N = 152) 81
表4-5-3術後譫妄之主要預測因子－簡單邏輯斯迴歸之結果 85
表4-5-4術後譫妄之主要預測因子－多元邏輯斯迴歸分析之結果 85
表4-5-5術前有無衰弱分組與術後譫妄之預測因子分析1 87
表4-5-6術前有無衰弱分組與術後譫妄之預測因子分析2 87
圖3-1-1研究者參與流程圖 42
圖3-2-1研究架構 43
圖3-7-1資料收集流程圖 57

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