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研究生:賴玟苑
研究生(外文):Wen-Yuan Lai
論文名稱:探討尿液酸鹼值及攝液量對加護病房導尿管留置病患泌尿道感染之預測成效
論文名稱(外文):Explore monitoring urine PH and fluid intake of ICU patient with Indwelling urinary catheter on predicting the occurrence urinary tract infection
指導教授:林淑媛林淑媛引用關係
指導教授(外文):Shu-Yuan Lin
學位類別:碩士
校院名稱:高雄醫學大學
系所名稱:護理學研究所
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:2013
畢業學年度:101
語文別:中文
論文頁數:87
中文關鍵詞:導尿管相關泌尿道感染尿液酸鹼值攝液量尿液滲透壓尿比重
外文關鍵詞:Catheter-associated urinary tract infectionurine pHfluid intakeurine osmolarityspecific gravity
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導尿管留置相關泌尿道感染為常見的院內感染之一,加護病房常因病患病況需要而有導尿管留置,加護病房導尿管留置相關泌尿道感染密度高達5.1‰。本研究旨在探討尿液酸鹼值及攝液量與加護病房導尿管病患泌尿道感染發生之關係。
研究採用縱貫性歷史研究設計,採立意取樣,以高雄某醫學中心加護病房作為研究場所,收案對象為有導尿管留罝無泌尿道感染之病患,共收案61位。收案工具包括:人口學及疾病特性調查表、泌尿道感染症狀調查表、輸入及排出量表及尿液酸鹼試紙及測定儀;施測時機為收案隔天及轉出加護病房前或轉到病房的隔天;使用SPSS 20.0版本軟體進行描述性統計及廣義估計方程式模式(generalized estimating equation)(GEE)之推論統計分析。
卡方及t檢定結果發現前、後測之尿液混濁、前測之尿比重及前、後測之尿液滲透壓不同分別在後測菌尿症的發生有顯著差異;GEE檢定結果發現尿液混濁為菌尿症之預測因子,建議未來能將尿液有無混濁當作菌尿症發生之偵測指標,以期能提早預測菌尿症之發生。


Catheter associated urinary tract infection is one of the most common nosocomial infections. The catheterization is often performed on the patients if they are under poor conditions in intensive care units (ICU). However, the incidence of catheter-associated urinary tract infection (CAUTI) in the intensive care units is up to 5.1 ‰. This study was attempted to explore the value of urine pH and fluid intake on the occurrence of urinary tract infection (UTI) for the patients with catheterization in ICU.
The longitudinal historical cohort design was adopted for this study, and the purposive sampling was selected for the patients with indwelling urinary catheter and were hospitalized in ICU at a medical center in Kaohsiung. Sixty-one patients participated in this study. The measurement tools include the questionnaires of demographic and disease characteristics, urinary tract infection symptoms questionnaire, intake and output record sheet, urine pH strip and pH test meter. The tests were started after the patients agree to participant the study until they were discharged from the ICU or transferred to the ward. The data were analyzed using chi-square and t-test for descriptive statistics and generalized estimating equation(GEE) for inferential statistics.
The results showed that there were significant differences between the first and second urine specific gravity, urine osmolarity, the second urine appearance with turbid and the second test of bacteriuria. It was find the urine appearance with turbid could be used as a predictor of bacteriuria based on the result of GEE. Thus, the urine appearance with or without turbid is recommended to be the indicator of bacteriuria for the early detection of bacteriuria.


目錄
頁次
致謝 …………………………………………………………… I
中文摘要 ……………………………………………………… II
英文摘要 ……………………………………………………… III
全文目錄 ……………………………………………………… V
附錄 …………………………………………………………. VII
第一章 緒論
第一節 研究動機與重要性 ………………………………… 1
第二節 研究目的與研究假設 ……………………………… 4
第二章 文獻查證、名詞定義與研究架構
第一節 導尿管相關泌尿道感染之發生率及發生機轉……… 5
第二節 預防導尿管相關泌尿道感染照護 ………………… 8
第三節 尿液酸鹼值與泌尿道感染之關係 ………………… 10
第四節 攝液量與泌尿道感染之關係 ……………………… 13
第五節 名詞定義 …………………………………………… 17
第六節 研究架構 …………………………………………… 20
第三章 研究方法
第一節 研究設計、研究場所與對象 ……………………… 21
第二節 研究工具 …………………………………………… 23
第三節 研究步驟與資料收集過程 ………………………….. 26
第四節 倫理考量 …………………………………………… 32
第四章 研究結果
第一節 受試者基本資料 …………………………………… 33
第二節 尿液檢查結果及攝液量之分佈 …………………….. 35
第三節 受試者基本資料、攝液量及尿液檢查結果與菌尿症之關係 …………………………………………………… 39
第四節 後測菌尿症之預測因子檢定 ……………………… 43
第五章 討論 ………………………………………………………
第一節 受試者特性、尿液檢查結果及攝液量與菌尿症之關
係 ………..……..…………………………………... 46
第二節 菌尿症之預測因子 ………………………………… 51
第三節 結論 ………………………………………………… 54
第六章 研究限制 ………………………………………………… 55
第七章 護理之運用與建議 ……………………………………… 56
參考文獻
中文部分 ……………………………………………………… 58
英文部分 ……………………………………………………… 60
附錄
附錄一 酸鹼測定儀 ………………………………………… 68
附錄二 受試者同意書 ……………………………………… 69
附錄三 個人及疾病特性調查表 ………………………….. 73
附錄四 各項檢驗值記錄表 ……………………………….. 74
附錄五 泌尿道感染症狀調查表及輸入排出量表 ………….. 75
附錄六 編碼及尿液檢體收集記錄表 ……………………….. 76
附錄七 研究步驟流程圖 …………………………………….. 77
附錄八 臨床試驗證明書 …………………………………….. 78


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