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研究生:邵蘊萍
研究生(外文):Yun-Ping Shao
論文名稱:長期照護住民的灌食鼻胃管衛生狀況與其影響因子研究
論文名稱(外文):Study of the Microbial Sanitary Conditions and their Affecting Factors of the Nasal-Feeding Tubes in Long-Term Care Facilities
指導教授:張正明張正明引用關係
指導教授(外文):Philip Cheng Ming Chang
學位類別:碩士
校院名稱:國立臺灣海洋大學
系所名稱:食品科學系
學門:農業科學學門
學類:食品科學類
論文種類:學術論文
論文出版年:2005
畢業學年度:93
語文別:中文
論文頁數:86
中文關鍵詞:鼻胃管血0清白蛋白身體質量指數年齡高血壓
外文關鍵詞:nasal-feeding tubeserum albuminBMIagehypertension
相關次數:
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灌食者易有腹瀉等併發症,除檢討配方安全性外,鼻胃管的衛生亦是重點,尤其是有高血壓史、營養不良及年長者,其鼻胃管成為細菌最佳寄生場所。因流體食物須藉由鼻胃管進入胃中,可能是導致易腹瀉的最大禍首,更需加強其他方面衛生管控。
本研究探討灌食者每日補充營養路徑所使用的鼻胃管衛生狀況,健保局規定居家長期照護二週給付一次使用PVC管費用,以衛生的角度來看是否合宜?並尋找影響鼻胃管衛生狀況的關連性因素。研究對象為護理之家及養護機構住民,共59位住民採用鼻胃管灌食(PU管4人、PVC管25人、silicone管30人),檢測所使用的鼻胃管內壁附著總生菌數作為衛生參考依據。
研究結果發現使用天數、管內凝結物、灌食配方、攝水量等對於管內壁總生菌數影響相關性不大,反之作為營養不良指標的血清白蛋白、BMI及年齡、高血壓與鼻胃管內壁附著總生菌數量有關,當以血清白蛋白小於3 g/dl及年齡80歲以上、有無高血壓史做分組,管內壁附著總生菌數有顯著差異。BMI小於17.6做分組亦有偏高現象但不顯著。雖然使用PVC或silicone管內壁附著總生菌數差異不大,但PVC鼻胃管因受胃酸侵蝕管子尾端皆已變硬,取出時對使用者造成極度不適,仍不宜擺放過久。
Patients with nasal feeding had complications often, like nausea, abdominal bloating, vomiting, diarrhea, aspiration pneumonia. Sanitation of nasal-feeding tube was important.
The purpose of this study is to investigate the sanitary status, in terms of total bacterial count, of nasal-feeding tubes. Since National Health Insurance covers the cost of the feeding tube for long-term care facilities on a fixed frequency of every two weeks/tube, it is interested to know if the frequency is justified by the sanitary condition of the tube during this period. Three types of nasal-feeding tubes (PU tube: 4, PVC tube: 25, silicone tube: 30) with a total of 59 tubes were collected from either nursing home or elderly care center in Taipei city. The demographic data, health history, nutrition status, and feeding formula were also gathered in order to establish the possible relationships between these factors.
Results indicate that the total aerobic counts of the feeding tube was significantly influenced by the patients’ serum albumin< 3 g/dl, BMI< 17.6, age≧80, and patients with hypertension. Material made of the feeding tube showed no significant influence on the bacterial counts between PVC and silicone nasal-feeding tubes. However, the hardening progress of the PVC tubes during feeding period was noticed as may induced by long term exposure to gastric acid and the clogging of the silicone tube was another problem for feeding with viscous formula.
目錄
壹、前言…………………………………………………………… 4
貳、文獻整理……………………………………………………… 7
一、灌食發展歷史………………………………………………… 7
二、餵食管的變革………………………………………………… 8
三、餵食管的微生物附著………………………………………… 11
四、灌食系統……………………………………………………… 16
五、製備灌食配方的衛生評估…………………………………… 17
六、灌食配方種類的差異對配方內菌數的影響………………… 18
七、灌食與併發症之關係………………………………………… 19
(一)腹瀉…………………………………………………………… 19
(二)肺炎之關係探討……………………………………………… 20
八、長期照護機構住民的營養狀況……………………………… 20
九、營養評估……………………………………………………… 22
(一)身體質量指數……………………………………………… 23
(二)血清白蛋白………………………………………………… 24
參、研究目的……………………………………………………… 26
肆、材料與方法…………………………………………………… 28
一、實驗大綱……………………………………………………… 28
二、實驗材料與藥品……………………………………………… 29
三、實驗方法……………………………………………………… 30
四、統計方法……………………………………………………… 32
伍、結果與討論…………………………………………………… 33
一、實驗者基本資料……………………………………………… 33
二、鼻胃管硬化情形……………………………………………… 33
三、鼻胃管阻塞情形……………………………………………… 34
四、影響鼻胃管內壁菌量因素探討……………………………… 35
(一)使用天數…………………………………………………… 36
(二)年齡………………………………………………………… 36
(三)身體質量指數(BMI)…………………………………… 37
(四)血清白蛋白………………………………………………… 39
(五)性別………………………………………………………… 41
(六)鼻胃管材質………………………………………………… 41
(七)鼻胃管內凝結物…………………………………………… 44
(八)灌食配方…………………………………………………… 43
(九)氣切………………………………………………………… 46
(十)疾病………………………………………………………… 47
(十一)灌食水量………………………………………………… 49
陸、結論…………………………………………………………… 52
柒、參考文獻……………………………………………………… 55
捌、附錄…………………………………………………………… 86
















表目錄
表一、使用鼻胃管餵食之住民基本資料……………………… 64
表二、灌食者使用不同灌食鼻胃管使用天數………………… 64
表三、灌食者使用不同灌食鼻胃管硬化情形………………… 65
表四、灌食者使用不同灌食鼻胃管內附著凝結物情形………… 65
表五、鼻胃管管內壁附著總生菌數量………………………… 66
表六、鼻胃管內壁附著菌數與住民的每日攝水量、年齡、血清白蛋白、BMI之關係………………………………… 66
表七、灌食者使用餵食鼻胃管管內壁附著總生菌數量與年齡、性別、BMI、血清白蛋白、管有凝結物分組之比較…… 67
表八、住民使用不同餵食鼻胃管材質、配方之管內壁附著總生菌比較表…………………………………………… 68
表九、灌食者使用餵食鼻胃管管內壁附著總生菌數量與管內凝結物、氣切、疾病數分組之比較……………………… 69
表十、高血壓與非高血壓患者年齡比較……………………… 70
表十一、鼻胃管內壁附著菌量影響因子複回歸分析表………… 70



圖目錄
圖一、使用鼻胃管餵食之住民居所、性別、灌食管比例餅圖…… 71
圖二、各種鼻胃管………………………………………………… 72
圖三、不同使用天數之PVC鼻胃管硬化情形…………………… 73
圖四、PVC鼻胃管硬化情形……………………………………… 74
圖五、silicone鼻胃管內壁附著凝結物情形……………………… 75
圖六、使用天數不同之silicone鼻胃管內壁附著凝結物情形…… 76
圖七、使用不同灌食配方對silicone鼻胃管內凝結物之影響…… 77
圖八、鼻胃管內壁附著菌量與使用天數之關係圖……………… 78
圖九、 三種灌食鼻胃管使用天數與內壁附著單位菌量之關係… 79
圖十、灌食者年齡與使用餵食鼻胃管附著單位菌量之關係…… 80
圖十一、住民身體質量指數(BMI)與使用餵食鼻胃管附著單位菌量之關係…………………………………………… 81
圖十二、住民血清白蛋白與鼻胃管附著單位菌量之關係……… 82
圖十三、灌食配方使用情形……………………………………… 83
圖十四、住民的疾病數量人次統計直條圖……………………… 84
圖十五、住民的疾病數與鼻胃管內壁附著單位菌量平均數直條圖………………………………………………………… 85
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