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研究生:黃惠滿
研究生(外文):Huang Hui-man
論文名稱:觸摸對早產兒抽痰後生理指標影響之探討
論文名稱(外文):The effect of gentle human touch on physiological parameters in preterm infants with suction
指導教授:王如華王如華引用關係白璐白璐引用關係陸振翮陸振翮引用關係
學位類別:碩士
校院名稱:國防醫學院
系所名稱:護理研究所
學門:醫藥衛生學門
學類:護理學類
論文種類:學術論文
論文出版年:2001
畢業學年度:90
語文別:中文
論文頁數:104
中文關鍵詞:觸摸早產兒抽痰護理生理指標
外文關鍵詞:gentle human touchpreterm infantssuctionphysiological parameters
相關次數:
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  • 下載下載:182
  • 收藏至我的研究室書目清單書目收藏:1
在新生兒加護病房中,抽痰為常見之臨床護理處置,然而,抽痰雖然能去除呼吸道的分泌物,預防呼吸道的阻塞,但也會導致其他負面的反應。因此,基於早產兒之生理週期性的變化以及不干擾常規性醫療照護的情況下,提供更多可減輕嬰兒因抽痰而引發之生理壓力,以及臨床實用性較高之護理措施實為刻不容緩之事。針對嬰兒之觸摸護理應用,為依據發展性照護提供有計劃性的觸覺刺激,除了可增加早產兒生理之穩定性,促進舒適感及減緩壓力之外,並能提昇嬰兒與照顧者間情感之交流,其在護理之應用上具正向成效。故本研究即基於早產兒的特性,探討抽痰後提供有計劃性的皮膚觸摸,其生理指標之影響與臨床應用之實際效果。
本研究採用自我交叉研究設計(crossover study design),相同之個案在兩天的研究過程中,兩次為實驗期,兩次為控制期。研究對象主要為北部兩家醫學中心以及一家區域醫院新生兒加護病房之早產兒。採便利取樣方式(convenience sampling),共選取30名妊娠週數28~32週,診斷為呼吸窘迫症候群(Respiratory Distress Syndrome, RDS)且使用呼吸器之早產兒進行研究。以HP monitor為測量工具,取得心跳速率與血氧濃度之數值,經由多次生理指標之記錄,觀察個案在抽痰前4分鐘之參考值、抽痰時、以及抽痰後30分鐘接受觸摸時(實驗期)與未接受觸摸時(控制期),其心跳速率與動脈血氧濃度確實的數值變化,以及回復時間之差異,以為觸摸措施實際效果分析之資料。研究所得資料以SPSS 9.0/Win2000套裝軟體進行平均值、標準差、配對t檢定及單因子變異分析等統計分析。
研究結果發現,早產兒接受觸摸措施後,其心跳速率與血氧濃度回復至參考值之時間減少,較未接受觸摸時為短,在心跳速率方面具統計之顯著意義(P<.05);早產兒抽痰後接受觸摸比沒接受觸摸時,其心跳速率與血氧濃度之改變量較小(P<.05);在回復至參考值之次數方面,接受觸摸措施時,較未接受觸摸時多次,且具統計上之顯著性(P<.05)。而早產兒提供觸摸措施之效果,會受到出生體重與疾病嚴重度之影響。
整體而言,觸摸措施可達到減緩早產兒抽痰後生理變化之實際效果。觸摸護理措施是以人與人之接觸為起點,進而傳遞溫暖與安全之感覺,其完全為護理工作中關懷(caring)之極至表現,企盼往後護理常規中能適時給予觸摸措施,以延續高品質之護理,並為早產兒之成長盡一份心力。
In the neonatal intensive care unit, suction is a very
common nursing implementation in preterm infant’s care.
In spite of eliminating airway secretion and avoiding airway
obstruction, it can cause serious negative responses to preterm infants. For physiologic circadian rhythm of preterm infants and uninterrupted routine works, it is important to decrease complication and enhance the quality of care. The gentle human touch is a developmental care to preterm infants, it not only increases the stability of physiological parameter and reduces the distress, but also improves the interaction between infants and nurses. It has already been confirmed that gentle human touch is beneficial to preterm infants . This study was designed to explore the effects of gentle touch on the clinical improvement of mechanically ventilated preterm infants when they are receiving suction procedure.
A crossover study design was adopted to this research. Thirty preterm infants from neonatal intensive care unit in two medical centers and one regional hospital were selected to participate this study. The participants were repeated measured when receiving suction, and divided as two phases which were the controlled phase and the experimental phase. Four minutes before suction, HP monitor was used to monitor the preterm infants and collect data of heart rate and oxygen saturation level. Thirty minutes after suction, the same physical indicators were recorded every minute to analyze the clinical effect of gentle human touch. Collected data were analyzed by descriptive and inferential statistic methods.
The results indicated that the preterm infants who received gentle human touch had less physical fluctuation after suction and took less time to restore physical distress after suction (P <.05), and the heart rate back to the baseline data faster than that did not receive gentle human touch (P <.05). Furthermore, this study found that the factors influencing the effect were the attributes of birth body weight and the severity of the disease.
To sum up, gentle human touch could alleviate physical fluctuation of preterm infants when they are receiving suction. Touch is based on interaction of human, which not only can deliver the warmth and safety, but also be the performance of caring. Therefore, it is hoped that giving appropriate gentle human touch will keep high quality of nursing care and assist preterm infant’s growth and development.
第一章 緒論
第一節 研究動機與重要性
第二節 研究目的
第二章 文獻探討
第一節 早產兒之生理病理
第二節 觸摸
第三節 抽痰護理措施對早產兒之影響
第四節 概念架構
第五節 名詞界定
第六節 研究問題
第七節 研究假設
第三章 研究方法
第一節 研究設計
第二節 研究對象與場所
第三節 研究工具
第四節 資料收集之過程
第五節 資料處理與分析
第四章 研究結果
第一節 研究對象之基本資料
第二節 個人基本屬性對生理指標之影響
第三節 早產兒接受抽痰護理其生理指標之影響
第四節 觸摸護理措施對早產兒抽痰後生理指標之影響
第五節 個案生理指標與觸摸措施及基本屬性之關係
第五章 討論
第一節 早產兒接受抽痰護理前後生理指標變化之分析
第二節 觸摸護理措施對早產兒抽痰後生理指標影響之分析
第三節 影響早產兒生理指標之相關因素分析
第四節 影響早產兒接受觸摸生理指標之相關因素分析
第六章 結論與建議
第一節 結論
第二節 護理上之應用
第三節 研究限制與建議
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1. 陳琍(1981)•早產兒護理•國防醫學,10(1),52-55。
2. 陳美津(1996)•加護病房新生兒之感覺刺激•護理新象,6(3),16-27。
3. 徐麗華(1995)•早產兒護理面面觀•護理雜誌,42(3),37-42。
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