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研究生:林豫亭
研究生(外文):Yu-Ting Lin
論文名稱:探討小兒加護病房病童之SpO2與SaO2的關係
論文名稱(外文):Detection of Relationship between SpO2 and SaO2 in Pediatric Intensive Care Unit
指導教授:郭碧照郭碧照引用關係
指導教授(外文):Bih-Jaw Kuo
學位類別:碩士
校院名稱:中山醫學大學
系所名稱:醫學研究所
學門:醫藥衛生學門
學類:醫學學類
論文種類:學術論文
論文出版年:2003
畢業學年度:91
語文別:中文
論文頁數:73
中文關鍵詞:脈動式氧合測量器SpO2值SaO2值
外文關鍵詞:Pulse oximetrySpO2 valueSaO2 value
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加護病房中的病童多以脈動式氧合測量器監測氧氣飽和度(SpO2),但在臨床上有SpO2值與SaO2值相差甚遠的情形存在。因此,本研究目的探討:一、SpO2值與SaO2值是否有差異?二、SpO2值的正確性受到那些因素的影響?三、SpO2值與SaO2值相關程度為多少?四、是否能以SpO2值預測SaO2值?五、臨床上SpO2值的警戒線為何?本研究採橫斷面描述型的調查研究法。以中部某醫學中心小兒心臟加護病房的病童為可及母群體,記錄SpO2值及SaO2值,且收集記錄病童臨床病況,共收集46名個案,458筆資料。將收集的資料針對SpO2值與SaO2值進行統計分析,其結果為:本研究樣本的SpO2值與SaO2值有差異性存在,但兩者相關性高;SpO2值之正確性與病患的血球容積、膽紅素值、動脈血中的酸鹼度、動脈血中二氧化碳濃度、動脈血中氧濃度、是否靜脈注射冠狀動脈擴張劑(NTG)及是否靜脈滴注PGE1等變項間有關,而與病患的體溫、脈動式氧合測量器置放的部位、血中鈣離子濃度、血紅素濃度及是否靜脈輸注血管收縮劑等變項與SpO2值之正確性之間無關;以SpO2值能夠有效預測SaO2值,所得的迴歸方程式為:SaO2檢驗值=-9.029+1.085 SpO2測量值;當脈動式氧合測量器的測量值小於93﹪時,臨床工作人員需密切注意病患是否出現缺氧的徵象。由本研究可了解醫護人員在使用脈動式氧合測量器時,需對其系統之原理、使用限制和適應症有所了解,才能更有效預測病人的病況,進而促進護理品質。
Pulse oximetry is widely used as a monitoring technology in operation room, intensive care unit, and other areas. This method is noninvasive, simple to operate, and adaptable to various patient population. But, some clinical limitations of pulse oximetry had been highlighted. The aim of the study was to detect relationship between SpO2and SaO2.
This was a descriptive study. There were 46 pediatric patients with congenital heart disease (CHD), whom were studied in pediatric intensive care unit (PICU). We collected patients’ conditions, SpO2 values, and SaO2 values. Noninvasive SpO2 was determined by a pulse oximetry (N-25; Nellor Oxisensor II N-25), was compared with direct arterial blood oxygen saturation (SaO2) measured by a cooximetry (GEM-PREMIER: blood gas/ electrolyte analyzer, model 5300).
SpO2 values and SaO2 values were compared using paired t-test, a significant difference was found (t=5.984, p<0.01). Pearson correlation coefficients between pulse oximetry (SpO2) and direct blood oxygen saturation (SaO2) measurement was 0.920 (p<0.01). For SpO2 values and SaO2 values, there was significant correlation between hematocrit (Hct), bilirubin level, arterial oxygen partial pressure (PaO2), arterial carbon dioxide partial pressure (PaCO2), arterial blood of acid-base level (PH), NTG use, and PGE1 use. For SpO2 values and SaO2 values, there was no significant correlation between patient’s temperature, calcium level, position of pulse oximetry, and vasoconstrictor use. The linear regression equation for predicting SaO2 values from SpO2 values was found to be Y= -9.029 + 1.085X. Bland and Altman method was applied. The difference between the two methods (arterial oxygen saturation, determined noninvasively by pulse oximetry of SpO2, and in vitro analysis of SaO2), was -1.70%, with SpO2 values higher than SaO2 values, and limits of agreement (mean±2SD) ranged from -10.07% to 6.67%.
The ability of pulse oximetry to reliably predict change in SaO2 based on change in pulse oximetry was limited. We recommend measurement PaO2 or SaO2 for important clinical decisions. Nursing care based on knowledge of these limitations and controversial factors associated with the device will enhance the quality of clinical care.
目錄…………………………………………………………………………2
圖表目錄……………………………………………………………………5
中文摘要……………………………………………………………………6
英文摘要……………………………………………………………………7
第一章 緒論
第一節 研究背景及動機…………………………………………………8
第二節 對護理的重要性……………………………………………….10
第三節 研究目的……………………………………………………….11
第四節 名詞界定……………………………………………………….11
第二章 文獻查證
第一節 細胞氧合代謝作用與脈動式氧合測量器的關係…………….12
第二節 脈動式氧合測量器的原理…………………………………….13
第三節 脈動式氧合測量器的限制…………………………………….16
第四節 脈動式氧合測量器之使用部位及適應症…………………….17
第五節 脈動式氧合測量器的使用方法……………………………….19
第六節 影響SpO2測量值準確性的因素……………………………….20
第三章 研究方法
第一節 研究設計……………………………………………………….27
第二節 研究的母群體與樣本………………………………………….27
第三節 資料收集步驟………………………………………………….27
第四節 資料分析……………………………………………………….28
第四章 研究結果
第一節 研究對象之人口學資料……………………………………….29
第二節 SpO2測量值與SaO2檢驗值的差異性………………………….31
第三節 SpO2測量值與SaO2檢驗值的偏差值………………………….36
第四節 影響SpO2測量值正確性之相關因素………………………….38
第五節 探討影響SpO2測量值不正確之相關危險因子的相對重要性…41
第六節 SpO2測量值與SaO2檢驗值之相關程度……………………….45
第七節 以SpO2測量值預測SaO2檢驗值……………………………….51
第八節 SpO2測量值的警戒線………………………………………….52
第五章 討論
第一節 SpO2測量值和SaO2檢驗值的差異性與相關性……………….54
第二節 影響SpO2測量值正確性之相關因素………………………….55
第三節 動脈血氧(PaO2)濃度對SpO2值與SaO2值之相關程度的影響…56
第四節 脈動式氧合測量器置放的部位……………………………….57
第五節 SpO2測量值的警戒線………………………………………….58
第六章 結論
第一節 結論…………………………………………………………….61
第二節 於臨床護理上的應用………………………………………….63
第三節 研究限制……………………………………………………….64
參考文獻………………………………………………………………….65
附錄
附表一 研究資料收集表……………………………………………….73
圖 表 目 錄
圖一 血紅素及去氧血紅素對光譜的吸收係數變化………………….14
圖二 SaO2檢驗值和SpO2測量值的偏差值…………………………….37
圖三 SpO2測量值與SaO2檢驗值兩變項的變動關係………………….51
圖四 SpO2為91﹪時各個案PaO2值的分布情形……………………….52
圖五 SpO2為92﹪時各個案PaO2值的分布情形………………………53
圖六 SpO2為93﹪時各個案PaO2值的分布情形……………………….53
表1 研究對象之人口學資料分析……………………………………….30
表2-1 研究對象在不同臨床狀況下其SpO2測量值與SaO2檢驗值的差….34
表2-2 研究對象在不同臨床狀況下其SpO2測量值與SaO2檢驗值的差異.35
表3-1 研究對象在不同臨床狀況下與SpO2測量值正確性之相關性……39
表3-2 研究對象在不同臨床狀況下與SpO2測量值正確性之相關性……40
表4-1 影響SpO 2測量值不正確之相關危險因子的相對重要性……….43
表4-2 影響SpO 2測量值不正確之相關危險因子的相對重要性……….44
表5-1 研究對象在不同臨床狀況下其SpO2測量值與SaO2檢驗值之相關程度..49
表5-2 研究對象在不同臨床狀況下其SpO2測量值與SaO2檢驗值之相關程度…50
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