(44.192.112.123) 您好!臺灣時間:2021/03/04 05:50
字體大小: 字級放大   字級縮小   預設字形  
回查詢結果

詳目顯示:::

我願授權國圖
: 
twitterline
研究生:黃智傑
研究生(外文):HUANG-JYH-JYE
論文名稱:呼吸加護病房簽署不施行心肺復甦術同意書與急救醫療處置施行之相關因素分析
論文名稱(外文):TheRelated Factorsof DNR and Emergency medical Treatment forCritical illPatientsin the RICU
指導教授:黃采薇黃采薇引用關係
學位類別:碩士
校院名稱:弘光科技大學
系所名稱:護理研究所
學門:醫藥衛生學門
學類:護理學類
論文種類:學術論文
畢業學年度:102
語文別:中文
論文頁數:56
中文關鍵詞:呼吸加護病房不施行心肺復甦術急救醫療處置
外文關鍵詞:Respiratory ICUdo not resuscitateemergency medical treatment
相關次數:
  • 被引用被引用:0
  • 點閱點閱:266
  • 評分評分:系統版面圖檔系統版面圖檔系統版面圖檔系統版面圖檔系統版面圖檔
  • 下載下載:0
  • 收藏至我的研究室書目清單書目收藏:1
研究背景:有越來越多重症病人在加護病房進入生命末期,即使有簽署不施行心肺復甦術同意書(Do Not Resuscitate,DNR),在臨床積極治療無效後,想轉安寧緩和病房時間通常已嫌太晚,造成病人及家屬的遺憾。研究目的:探討呼吸加護病房簽署不施行心肺復甦術同意書與急救醫療處置施行之相關因素分析。研究設計:本研究為回溯性研究,對象在台灣中部地區某醫學中心呼吸加護病房,自2008年1月至2011年12月底入住呼吸加護病房,年滿二十歲有肺癌或慢性阻塞性肺疾病病人,APACHEII分數≧20分之重症病人。以自擬之研究工具「加護病房病人簽署不施行心肺復甦術同意書對急救醫療處置之相關調查表」進行資料收集。研究結果:共計304人,有簽署DNR病人148人,未簽署DNR者156人。所得資料以卡方檢定、t檢定、相關性分析及羅吉斯迴歸檢定分析。研究結果發現:呼吸加護病房病人簽署DNR之急救醫療處置結果,肺癌病人及慢性阻塞性肺疾病病人對於急救醫療處置項目中,使用血管升壓劑及接受插管處置最多,高於其他項目,其中有簽署DNR病人使用血管升壓劑為79.1%,另外,接受插管處置為85.1%。呼吸加護病房重症病人接受緊急醫療處置之預測因子:結果顯示病人APACHE II越高、入住加護病房時間越長、有簽署DNR能預測有無使用血管升壓劑;病人APACHE II越高、年齡較輕能預測有無使用急救藥物;入住加護病房天數越短及年齡較輕能預測有無接受心外按摩處置;病人入住加護病房天數越長、沒簽署DNR、已婚、由病房轉入能預測有無接受插管處置。結論:此研究顯示304個病人中,有簽署DNR者148人(48.7%),其中簽署DNR死亡為115人(77.7%),病人在使用血管升壓劑比率高,預後不好,可以提供今後加護病房醫護人員面對病人及家屬同意簽署DNR時之臨床實證參考,期望能提升臨床照護病人的品質。
Background:There are more and more patient in the ICU into the end of life,the patients even if no sign Resuscitate Consent (Do Not Resuscitate,DNR).The patientinthe terminal stage still active inthe clinical treatment.Some patients would like to turn palliative to care,but usually had too late.Itcaused the the families of regret.
Objective:Toinvestigate therelated factors of DNR consent in respiratoryICUand the implementation ofthe emergencymedical treatment.
Study Design:This study wasa retrospective study. The data collected by the respiratory intensive care in a medical center of central Taiwan in since January 2008 by the end of December 2011 to stay respiratory intensive care unit. Theinclusion criteria waslung cancer or chronic obstructive Pulmonary Disease ,APACHE II scores≧20 points. The questionnaire was “ICU patient not Resuscitate signed consent form for medical treatment “for data collection. Data were analyzed by descriptive and infernal statistics(Chi-square test or Fisher`s exact test, T test, and logistic regression).
Results: A total of 304 patients comprising 148(48.7%) who had the DNR consent. The results showed that a total of 304 patients were included, whereas 148 patients had signed the DNR consent. The most data of emergency treatment in respiratory ICU were: sign on DNR patients with vasopressor agents (79.1%) and with Endo (85.1%). The results of multiple logistic regression showed that the predictors of using vasopressor agents were: APACHE II (Wald=15.243, p=.000), the duration of living in respiratory ICU (Wald=9.222,p=.002) and signed DNR consent (Wald=19.069, p=.000). The predictors of emergency agents were: APACHE II (Wald=4.950, p=.026) and younger age (Wald=4.940, p=.002). The predictors of cardiac massage treatment were: the duration of living in respiratory ICU (Wald=4.239, p=.039) and younger age (Wald=5.405, p=.020). The predictors of Endo intubation were: the duration of living in respiratory ICU (Wald=8.208, p=.004), without DNR consent (Wald=4.035,p=.045), marriage(Wald=7.828, p=.005) and transfer from ward(Wald=7.828, p=.005). These results are valuable in providing high quality care of respiratory ICU patients.
Conclusion:The results of study showed that 148(48.7%) of the 304 patients provided informed consent of do-not-resucitate (DNR).The mortality rate of DNR group was 115(77.7%).Patients were more and more use of vasopressor agants,had poor prognosis.It is suggested that encouraging the medical personnel to discuss the DNR consent earlier with patients and their families,the better decision could be made.

目錄
致謝..........................................................................................................I
論文摘要.................................................................................................II
Abstract..................................................................................................III
目錄........................................................................................................V
表目錄...................................................................................................VII
圖目錄..................................................................................................VIII
第一章緒論.............................................................................................1
第一節研究動機..................................................................................1
第二節研究重要性..............................................................................2
第三節研究目的..................................................................................3
第四節研究問題....................................................................................3
第五節名詞解釋及操作性定義............................................................3
第二章文獻查證.....................................................................................5
第一節肺部重症疾病與其特性............................................................5
第二節加護病房病人之醫療處置.........................................................8
第三節加護病房病人之重症末期醫療照護........................................10
第四節不施行心肺復甦術的起源及定義............................................10
第五節加護病房病人簽署DNR之相關研究......................................11
第三章研究方法...................................................................................14
第一節研究架構................................................................................14
第二節研究假說................................................................................14
第三節研究設計................................................................................15
第四節研究場所及研究對象..............................................................15
第五節研究工具................................................................................15
第六節研究倫理考量.........................................................................16
第七節資料處理與分析.....................................................................17
第四章結果與分析................................................................................18
第一節呼吸加護病房病人簽署DNR之急救醫療處置結果................18
第二節呼吸加護病房重症病人接受緊急醫療處置之預測因子.............40
第五章討論.............................................................................................44
第一節呼吸加護病房病人簽署DNR之急救醫療處置結果................44
第二節呼吸加護病房重症病人接受緊急醫療處置之預測因子.............45
第六章結論與建議..................................................................................47
第一節結論.......................................................................................47
第二節研究限制................................................................................47
第三節建議.......................................................................................48
附件.......................................................................................................50
參考文獻................................................................................................52

參考文獻
古世基、余忠仁(2010) ‧台灣地區呼吸器依賴患者醫療體系及病患照護之回饋‧中華民國重症醫學雜誌.,11,25-31。
立法院(2013,1月9日) ‧安寧緩和醫療條例部分條例修正案‧2013年10月20日取自http:glin.ly.gov.tw。
行政院衛生署(2012) ‧衛生死亡統計‧2012年12月1日取自http://www.doh.gov.tw/statisic/index.htm
吳莉芬、賴慧文、潘雪幸(2011)‧一位肺癌末期病患接受安寧療護之護理經驗‧腫瘤護理雜誌,11(1),37-47。
侯生擁、李如萍(2009) ‧護理人員照護癌末呼吸困難病人的知識、態度與行為趨向之研究‧護理雜誌,56(3)46-55。
郭正典(2002) ‧治療的限制與撤除‧中華民國重症醫學雜誌,4,310-317。
黃駿耀、吳耀光、黃崇旂、蔡熒煌( 2006) ‧癌症末期病患需要長期呼吸器之預後‧胸腔醫學,4(21),305-312。
黃國巡、胡美華、洪南凱、蔡建松、劉天健、廖文進(2010) ‧休克之臨床治療現況與趨勢‧護理雜誌,57(1),11-14。
楊嘉玲、陳慶餘、胡文郁(2008) ‧醫療預立指示‧安寧療護雜誌,13(1),30-41。
張美玉、劉惠玲(2000) ‧實用重症護理學‧台北:五南出版社。
張惠雯(2010) ‧慢性阻塞性肺病的末期醫療照護‧安寧療護雜誌,15(1),81-92。
陳慧秦、鄭文輝、林孟志( 2008) ‧由家屬的角度探討長期呼吸器依賴患者的照護問題‧台灣呼吸治療雜誌,7(2),1-19。
陳夏蓮(2007) ‧呼吸系統疾病病人護理‧內外科護理學(二版) ‧台北:華杏。
蔡翊新、林亞陵、黃勝堅(2007)‧重症病患之生命末期照護‧安寧療護‧12,312-320。53

趙可式(2007)‧醫師與生死‧台北:寶瓶文化。
劉會平(2004)‧肺炎診斷與治療‧腫瘤護理雜誌,4(2),25-33。
謝紅桂、顏妙芬(2001) ‧不予心肺復甦術之探討‧護理雜誌,48(3),75-78。
顧乃平、李從業(2002) ‧預立指示及倫理考量‧護理雜誌‧49(6)18-58。
Adams,N.,Poole,H.,& Richardson,C.(2006).Psychological approaches to chronic pain management:Part 1.Journal of Clinical Nursing,15(3),290-300.
American Joint committee on cancer 〔AJCC〕(2009,October 14).American Joint committee on cancer:AJCC releases 7thedition of cancer staging manual.Retrieved May 30.2012,from
htt://www.cancerstaging.org/news/pressrelease 1009.html
Ambrosino,N.,Simonds,A.(2007).The clinical management in extremely severe COPD.Respir Med,101,1613-24.
Boyd,K.,Teres,D.,Rapoport,J.,&Lemeshow,S.(1996).The relationship between age and the use of DNR order in critical care patient:Evidence for age discrimination.Archives of Internal Medicine,156(16),1821-1826.
Bacchetta,M.D.,Eachempati,S.R.,Fins,J.J.,Hydo,L.,&Barie,P.S.(2006).Factors influencing DNR decision-making in a surgical ICU.Journal Amerian College of Surgeon,202(6),995-1000.
Britwistle,J.,&Nielsen,A.(1998).Do-not-resuscitate:an ethical dilemma for the decision-maker.British.
Journal of Nursing,7(9),543-549.
Campbell,M.L.,&Guzman,J.A.(2003).Impact of a proactive approach to improve end-of-life care in a medical ICU .Chest,123,266-271.
Closed-chest cardiac massage.JAMA ,173,1064-1067.
Knaus,WA.,Draper,EA.,Wagner DP,et al.(1985).The APACHE II:A 54

severity of disease classification system.Crit Care Med,13,818-828.
Cook,D.J.,Guyatt,G.H.,Jaeschke,R.,Reeve,J.,Spanier,A.,
King,D.,Molloy,D.W.,Willan A.,&Streiner,D.L.(1995).Determinants in Canadian health care workers of the decision to withdraw life support from the critically ill.Journal of the American Medical Association,273(9),703-708.
Elkington,H.,White ,P.,Addington-Hall J,et al.(2005).The healthcare needs of chronic obstructive pulmonary disease patients in the last year of life,Palliative Medicane,19,485-491.
Ferrand,E.,Robert,R.,Ingrand,P.,& Lemaire,F.(2001).Withholding and withdrawal of life support in intensive care units in France:A prospective survey.The Lancet,357(9249),9-14.
Gulshan,S.,Jean,F.,Dong,Z.,& James S,G.(2008).Continuty of care and ICU utilization during end of life.Archives internal Medicine ,169(1),81-86.
GOLD (Global Initiate for Chronic Obstructive Lung Disease): Strategy for diagnosis, management,and prevention of COPD.Retrieved November27,2013from[http://www.goldcopd.org/Guidelineitem.asp?l1=2&l2=1&intId=989].
Heyland,D.K.,& Trammer,J.,Feldman-Stewart,D.(2000).End-of-life decision making in the Seriously ill hospitalized patient:An organizing framework and result of a preliminary study ,Journal of palliative Care,16(Supplement ),S31-39.
Ho,K.M.,&Liang,J.(2004).Withholding and withdrawal of Therapy in New Zealand ICUs:A survey of Clinical Directors.The Anaesthesia and intensive Care,32(6),718-786.
Huang,Y.C.,Huang,S.J.,Ko,W.J.(2010).Survey of do-not-resuscitate ordersinsurgicalintensivecare units. J Formos Med Assoc,109(3),201-208。
Janssen,DJA.,Spruit,MA.,Wouters,EFM.et.al.(2008).Daily symptom burden 55

in end-stage chronic orgam failure:A systematic review.Palliat Med,22,938-948.
Jayes,R.L.,Zimmerman J.E.,Wagner,D.p.,&Knaus,W.A.(1996).Variations in the use of do-not-resusciate orders in ICUs.Findings from a national study .Chest,110,185-190.
Kouwenhoven,WB.,Jude,JR.,Knickerbocker,GG.,(1960).
Kranidiotis,G.,Gerovasili,V.,Tasoulis,A.,&Nanas,S.(2010).End-of-life decisions in Greek intensive care units:a multicenter cohort study,kranidiotis et al.Critical Care,14,2-9.
Kouch,M.(2006).Managing Symptoms for A“Good Death”.Nuring.36(11),58-63.
Kam,S.L.,Doris Man,W.T,Tracy Wai,T.C.,Po,T.L.,Wai,M.L.,& Kin,S.C.(2010).Comparing Noncancer and Cancer Deaths in Hong Kong:A Retrospective Review,Journal of pain and Symptom Management,40(5),704-714.
Lin,Y.C.,Tsai,Y.H.,Huang,C.C.,Hsu,K.H.,Wang,S.W.,Tsao,Y.C.,& Lin,M.C.(2003).Outcome of lung cacer patient with acute respiratory failure reguiring mechanical ventilation.Respirtory Medicine,98,43-51.
Murphy,P.,&Price,D.(2007).How to avoid DNR miscommunications.Nursing Management,38(3),17-20.
Marcio Soares,J.I.,Salluh,V.B.L,& Juliana,V.R.(2008).Short-and Long-term Outcomes of Critically III Patients With Cancer and Prolonged ICU Length of Stay,American College of Chest Physicins,134(3),520-526.
Mani,R.K.,Mandal,A.K.,Bal,S.,Javeri,Y.,kumar,R.,Nama,D.K.,Pandey,P.,Rawat,T.,Singh,N.,Tewari,H.,&Uttam,R.(2009).End-of-life decisions in an Indian intensive care unit,Intensive Care Med,35,1713-1719.
Quon, B.S.,Gan, W.Q.,& Sin D.D.(2008).Contemporary management of acute exacerbations of COPD.Chest,133(756-766).
Quill,T.E.,& Robert,Quill,T.E.,& Robert,Quill,T.E.,& Robert,Quill,T.E.,& Robert,Quill,T.E.,& Robert,Quill,T.E.,& Robert,Quill,T.E.,& Robert,Quill,T.E.,& Robert,Quill,T.E.,& Robert,Quill,T.E.,& Robert,Quill,T.E.,& Robert,Quill,T.E.,& Robert,Quill,T.E.,& Robert,Quill,T.E.,& Robert,Quill,T.E.,& Robert,Quill,T.E.,& Robert,Quill,T.E.,& Robert,Quill,T.E.,& Robert,Quill,T.E.,& Robert,Quill,T.E.,& Robert,H.(2011).TimeH.(2011).TimeH.(2011).TimeH.(2011).TimeH.(2011).TimeH.(2011).Time H.(2011).TimeH.(2011).TimeH.(2011).TimeH.(2011).TimeH.(2011).TimeH.(2011).Time-limited trials near the end of life.limited trials near the end of life.limited trials near

連結至畢業學校之論文網頁點我開啟連結
註: 此連結為研究生畢業學校所提供,不一定有電子全文可供下載,若連結有誤,請點選上方之〝勘誤回報〞功能,我們會盡快修正,謝謝!
QRCODE
 
 
 
 
 
                                                                                                                                                                                                                                                                                                                                                                                                               
第一頁 上一頁 下一頁 最後一頁 top
無相關論文
 
1. 古世基、余忠仁(2010) ‧台灣地區呼吸器依賴患者醫療體系及病患照護之回饋‧中華民國重症醫學雜誌.,11,25-31。
2. 古世基、余忠仁(2010) ‧台灣地區呼吸器依賴患者醫療體系及病患照護之回饋‧中華民國重症醫學雜誌.,11,25-31。
3. 吳莉芬、賴慧文、潘雪幸(2011)‧一位肺癌末期病患接受安寧療護之護理經驗‧腫瘤護理雜誌,11(1),37-47。
4. 吳莉芬、賴慧文、潘雪幸(2011)‧一位肺癌末期病患接受安寧療護之護理經驗‧腫瘤護理雜誌,11(1),37-47。
5. 郭正典(2002) ‧治療的限制與撤除‧中華民國重症醫學雜誌,4,310-317。
6. 郭正典(2002) ‧治療的限制與撤除‧中華民國重症醫學雜誌,4,310-317。
7. 楊嘉玲、陳慶餘、胡文郁(2008) ‧醫療預立指示‧安寧療護雜誌,13(1),30-41。
8. 楊嘉玲、陳慶餘、胡文郁(2008) ‧醫療預立指示‧安寧療護雜誌,13(1),30-41。
9. 張惠雯(2010) ‧慢性阻塞性肺病的末期醫療照護‧安寧療護雜誌,15(1),81-92。
10. 張惠雯(2010) ‧慢性阻塞性肺病的末期醫療照護‧安寧療護雜誌,15(1),81-92。
11. 陳慧秦、鄭文輝、林孟志( 2008) ‧由家屬的角度探討長期呼吸器依賴患者的照護問題‧台灣呼吸治療雜誌,7(2),1-19。
12. 陳慧秦、鄭文輝、林孟志( 2008) ‧由家屬的角度探討長期呼吸器依賴患者的照護問題‧台灣呼吸治療雜誌,7(2),1-19。
13. 蔡翊新、林亞陵、黃勝堅(2007)‧重症病患之生命末期照護‧安寧療護‧12,312-320。53
14. 蔡翊新、林亞陵、黃勝堅(2007)‧重症病患之生命末期照護‧安寧療護‧12,312-320。53
15. 謝紅桂、顏妙芬(2001) ‧不予心肺復甦術之探討‧護理雜誌,48(3),75-78。
 
系統版面圖檔 系統版面圖檔