臺灣博碩士論文加值系統

本研究目的在探討影響外科加護中心病患成功拔管之相關因素，並確立外科加護中心病患成功拔管之預測因素。研究方法為前瞻性研究。研究場所為北部某一醫學中心之外科加護中心，以接受外科手術病患且術後有氣管內管並使用呼吸器病患為研究對象，採立意取樣方式共收集117位符合選樣條件之個案。以個案紀錄表、外科加護中心接受手術病患使用呼吸器拔管評估單進行資料收集，最後記錄個案拔管時間，追蹤有無拔管失敗（於72小時內重插管）。研究資料以次數分配、百分比、平均值、標準差及排序呈現描述性資料，再以卡方檢定(Chi-square test)、獨立樣本t 檢定(independent-samples T test)、及邏輯式迴歸(logistic regression)等方法進行資料分析。
研究結果顯示，117位個案中，103位成功拔管，14位拔管失敗。兩組比較結果發現，成功拔管組脫離時最低的SpO2(98.72±1.50 V.S. 97.64±2.10；
p=0.02)較高，脫離時的APACHEⅡ(11.25±4.04 V.S. 14.21±5.18；p=0.01)較低，呼吸器使用時間(1.06±1.32天V.S.3.27±3.38天；p=0.03)及加護中心留置時間(2.85±2.23天V.S. 16.20±9.13天；p＜0.001) 較短。在外科加護中心接受手術病患使用呼吸器拔管評估單結果方面，平均總分20.86±2.67分，成功拔管組有較高的平均總分（21.24±2.22 V.S. 18.07±3.95；P=0.01)。將評估指標分七大項目作分析，成功拔管組「呼吸脫離指標評估」(093±0.12 V.S. 0.75±0.29；P=0.04)及「神經學及肌力狀態評估」（0.99±0.03 V.S. 0.90±0.20；p=0.08）平均分數較高。以邏輯逐步迴歸方式分析外科加護中心使用呼吸器病患成功拔管的預測因素，結果顯示呼吸器使用時間、神經學及肌力狀態評估、呼吸脫離指標評估等變項，為具統計顯著意義的預測因素。研究結果可提供臨床醫護人員在照護外科手術後呼吸器脫離並拔管之病患上的參考。

The purpose of this study was to examine the factors related to successful extubation and the most effective predictors of successful extubation in surgical intensive care unit patients with mechanical ventilator. A prospective design was used. 117 intubated patients after surgery were recruited from a surgical intensive care unit of medical center in northern Taiwan. Data was analyzed by frequency, percentage, mean, standard deviation, rank, Chi-square test, independent-samples T test, and logistic regression.
The results of this study were as follows：Of 117 intubated patients, 103 were successful extubation, and 14 were extubation failure (reintubation within 72 hours after planned extubation). The successful extubation patients had significantly higher minimal SpO2 during T tube trial (98.72±1.50 V.S. 97.64±
2.10; p=0.02), lower APACHE Ⅱ score (11.25±4.04 V.S. 14.21±5.18; p=0.01), shorter duration of mechanical ventilation (1.06±1.32 days V.S. 3.27±3.38days; p=0.03), and less time in the ICU (2.85±2.23days V.S. 16.20±9.13days; p<0.001) compared to the extubation failure patients. The mean total score of the inventory was 20.86±2.67, successful extubation patients had significantly higher total score(21.24±2.22 V.S. 18.07±3.95; P=0.01), means of 「neurological and musculoskeletal status assessment」(0.99±0.03 V.S. 0.90±0.20; p=0.08), and 「weaning parameter assessment」(093±0.12 V.S. 0.75±0.29; P=0.04). Finally, the result of stepwise logistic regression showed that the significant predictors of successful extubation were duration of mechanical ventilation, neurological and musculoskeletal status assessment, and weaning parameter assessment. The results of this study will be valuable in quality of care of extubation patients after surgery.

目錄
正文目錄......................................................Ⅰ
表目錄........................................................Ⅳ
圖目錄........................................................Ⅴ
附錄目錄......................................................Ⅵ
中文摘要......................................................Ⅶ
英文摘要......................................................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.............................................4
第二章 文獻查證
第一節 氣管插管之相關概念...................................5
第二節 成功拔管之相關概念..................................14
第三章 概念架構
第一節 概念架構............................................35
第二節 名詞界定............................................36
第四章 研究方法
第一節 研究設計............................................40
第二節 研究對象與場所......................................41
第三節 研究工具............................................42
第四節 資料收集過程........................................49
第五節 資料處理與分析......................................50
第六節 倫理考量............................................51
第五章 研究結果
第一節 外科加護中心病患基本屬性............................52
第二節 外科加護中心接受手術病患使用呼吸器拔管評估單得分....56
第三節 外科加護中心病患基本屬性與成功拔管之關係............59
第四節 外科加護中心接受手術病患使用呼吸器拔管評估單結果及與
成功拔管之關係......................................62
第五節 外科加護中心病患成功拔管之預測因素..................66
第六節 外科加護中心成功拔管病患手術後二十四小時成功拔管的影
響因素及預測因素....................................68
第六章 討論
第一節 外科加護中心病患基本屬性與成功拔管之關係............79
第二節 外科加護中心接受手術病患使用呼吸器拔管評估單結果及與
成功拔管之關係......................................86
第三節 外科加護中心病患成功拔管之預測因素..................89
第四節 外科加護中心成功拔管病患手術後二十四小時成功拔管的預
測因素..............................................92
第七章 結論與建議
第一節 結論................................................95
第二節 研究限制............................................97
第三節 應用與建議..........................................98
參考資料
中文部分...................................................101
英文部分................ ..................................104

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