臺灣博碩士論文加值系統

本研究旨在探討呼吸器脫離評估項目與呼吸器脫離結果之相關性。期望藉由這些評估項目瞭解病患在準備呼吸器脫離前的得分狀態，並決定呼吸器脫離評估項目得分與脫離呼吸器結果之相關性，並找出最能預測呼吸器使用超過三天以上病患，成功脫離呼吸器的預測因素，以作為發展呼吸器脫離護理措施之依據，使病患能及早脫離呼吸器，並減輕病患的焦慮及不適、家屬的擔心、害怕，並達到縮短住院天數、降低醫療成本之成效。
本研究採探索性研究法，主要是以27項六大類評估項目作為呼吸器脫離相關因素探討之評估指引，以進行資料收集。研究場所為中部某醫學中心之一般內科加護病房，共收案70位呼吸器使用超過三天之病患為研究對象，資料分析以百分比、平均值、標準差與排序呈現描述性資料，再以t-test、Chi-Square、Pearson correlation、logistic regression進行檢定。
研究結果發現：(一) 成功脫離呼吸器病患在呼吸器脫離訓練前其身
心評估後的整體準備度為71%；六大評估項目中，以心理評估方面的達
成率最高，臨床相關檢驗評估項目則是最低。27項脫離前評估項目的達
成率最低的前五項依序為「呼吸音正常」、「Albumin≧3.5gm/dl」、「自發性潮氣容積＞5ml/kg」、「快淺呼吸指標＜105/bpm/L」及「血中鈣離子介於8.5-10mg/dl、血中鎂離子介於1.7-2.1mg/dl、血中磷離子介於 2.5-5.5 mg/dl」。(二)基本屬性、六大類評估項目、27項評估項目達成率和脫離前呼吸器使用時間皆與呼吸器脫離花費時間無顯著相關。(三) 年齡（r=-0.38, p＜.01）、疾病嚴重度（r=-0.34, p＜.01）和呼吸器脫離結果呈顯著負相關，27項評估項目達成率（r=-0.62, p<.01)；六大評估項目中之呼吸脫離指標評估（r=0.42,p＜.01）、血液氣體分析評估（r=0.28, p=0.02）、心理評估項目（r=0.63, p＜.01）與脫離結果呈顯著正相關；呼吸器脫離前呼吸器使用時間（r=-0.27, p=.02）則與呼吸器脫離結果呈顯著負相關。(四)呼吸器脫離成功的預測變項為，心理評估方面、年齡、臨床相關檢驗、脫離指標，其總解釋量為61%。
研究結果可提供臨床醫護人員針對於呼吸器使用病患於脫離訓練前之照護參考。

The purpose of this research was to study correlations between ventilator assessment items and ventilator weaning outcome. To understand the achieving rate before ventilator weaning, and found out the most effective predictors of ventilator weaning outcome after using the ventilator over 3 days.
An explored and correlated design was used. A total of 70 cases that met the selection criteria were recruited in the study. Data were analyzed by percentage, mean, standard deviation, frequency, t-test, Chi-Square, Pearson correlation, and logistic regression.
The major findings of this study were as follows: (1) In the successful weaning group, the totally achieving rate was 71%. The best achieving category among the six assessment categories was the psychological category. The lowest achieving category was the category of clinical laboratory data. The first five lowest achieving items were 「normal breathing sound」,「Albumin ≧ 3.5 gm/dl」, 「spontaneous tidal volume＞5ml/kg」, 「rapid shallow breath index＜105/bpm/L」, 「calcium level in 8.5-10mg/dl」, 「magnesium level in 1.7 - 2.1mg/dl」, and 「phosphorous level in 2.5-5.5 mg/dl」. (2) Demographic characteristics, six assessment categories, the achieving rate of twenty-seven assessment items, and the time of ventilator using before weaning were not significantly correlated to the ventilator weaning outcome. (3) Age（r=-0.38, p＜.01）and APRCHE II （r=-0.34, p＜.01）were significantly correlated to ventilator weaning outcome. The achieving rate of twenty-seven assessment items （r=-0.62, p＜.01）, weaning profile （r=0.42, p＜.01）, arterial blood gas analysis（r=0.28, p=.02）, psychological category（r=0.63, p＜.01）were positive related to ventilator weaning outcome. The time of ventilator using before ventilator weaning（r=-0.27, p=.02）was negative correlated to ventilator weaning outcome. (4) The significant predictors of successful weaning included psychological category, age, clinical laboratory data, and blood gas data, the result of indicated of 61% variances.
The results of this study would be valuable in improvement of care quality of ventilator weaning.

目 錄
頁數
致 謝 ……………………………………………………………… I
中文摘要 ……………………………………………………………… III
英文摘要 ……………………………………………………………… V
目 錄 ……………………………………………………………… VII
圖表目次 ……………………………………………………………… IX
第一章 緒論
第一節 研究動機與重要性……………………………………… 1
第二節 研究目的………………………………………………… 3
第三節 名詞界定 ……………………………………………… 3
第二章 文獻查證
第一節 呼吸器的臨床使用……………………………………… 5
第二節 使用呼吸器患者的身心反應及相關護理措施…………16
第三節 呼吸器使用過程之評估量表……………………………20
第四節 呼吸器的脫離……………………………………………22
第三章 研究方法
第一節 研究設計…………………………………………………32
第二節 研究場所…………………………………………………32
第三節 研究對象…………………………………………………33
第四節 研究工具…………………………………………………34
第五節 資料收集過程及紀錄……………………………………42
第六節 資料分析與統計…………………………………………43
第四章 分析與結果
第一節 研究對象基本資料分析 ……………………………… 44
第二節 呼吸器脫離評估項目之得分分析 …………………… 47
第三節 基本屬性、呼吸器脫離評估項目、呼吸器脫離花費
時間及脫離結果的相關分析 ………………………… 52
第四節 呼吸器脫離成功之預測因素 ………………………… 55
第五章 討論
第一節 呼吸器脫離前評估 …………………………………… 57
第二節 變項間之相關性 …………………………………… 62
第三節 成功脫離呼吸器的預測因素 ………………………… 65
第六章結論與建議
第一節 結論 …………………………………………………… 69
第二節 研究限制 ……………………………………………… 71
第三節 應用與建議 …………………………………………… 72
參考資料
中文部分 ……………………………………………………… 75
英文部分 ……………………………………………………… 77
附錄
附錄一 內容效度專家資歷………………………………………86
附錄二 專家效度鑑定結果………………………………………87
附錄三 研究問卷之專家效度平均得分 ……………………… 88
附錄四 研究問卷各項之專家效度平均得分……………………89
附錄五 呼吸器脫離評估項目表…………………………………92
附錄六 個案基本資料表 ………………………………………93
附錄七 修正的伯格呼吸困難指數………………………………94
附錄八 呼吸脫離指標測量工具…………………………………95
圖 表 目 次
表一 呼吸衰竭臨床理學檢查使用呼吸器之適應症 ………… 8
表二 正壓呼吸器與負壓呼吸器之各項比較 …………………11
表三 呼吸器脫離成功之預測指標 ……………………………23
表四 比較T-piece,IMV及PSV脫離呼吸器之優劣 ………… 29
表五 個案基本資料 ……………………………………… 46
表六 評估項目達成人次狀態 ……………………………… 49
表七 各項次評估項目之平均得分情形 ………………… 51
表八 研究對象基本屬性與六大評估項目及總得分之相關分
析 ……………………………………………………… 54
表九 呼吸器脫離結果之逐步複迴歸分析 ………………… 56

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