跳到主要內容

臺灣博碩士論文加值系統

(44.201.99.222) 您好!臺灣時間:2022/12/04 01:18
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

: 
twitterline
研究生:林秀華
研究生(外文):Hsiu-Hua Lin
論文名稱:燒傷成人病患腸道灌食與燒傷預後之相關性
論文名稱(外文):Relation of the Enteral Feeding and Prognosis in Patients with Adult Major Burns
指導教授:邱秀渝邱秀渝引用關係
指導教授(外文):Shiu-Yu Katie C. Lee
口試委員:劉介宇楊永健林文絹
口試委員(外文):Chieh-Yu LiuEng-Kean YeongWen-Chuan Lin
口試日期:2015-07-28
學位類別:碩士
校院名稱:國立臺北護理健康大學
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
論文出版年:2015
畢業學年度:103
語文別:中文
論文頁數:95
中文關鍵詞:燒傷腸道灌食預後灌食達成率
外文關鍵詞:major burnsenteral feedingprognosisenteral feeding calorie rate
相關次數:
  • 被引用被引用:0
  • 點閱點閱:186
  • 評分評分:
  • 下載下載:20
  • 收藏至我的研究室書目清單書目收藏:1
營養是傷口癒合的根基,尤其是重症燒傷患者在治療過程中,更需要大量且有效益的營養支持。本研究採世代研究設計,藉由病歷記錄資料,探討燒傷成人病患腸道灌食與燒傷預後之相關性。在收集了北部某醫學中心2006年3月1日至2015年3月期間,87位首次因燒傷入院且接受腸道營養治療之成人病患,入院至出院後30天或死亡之疾病、攝入與營養功能資料後,將資料匯入SPSS 20.0套裝軟體進行資料分析。本研究樣本平均年齡49.8歲,以男性(75.9%)、火焰燒傷(Flame Burn)(69.0%)、燒傷深度2-3度(59.8%)、燒傷面積少於40%者(67.8%)佔較多數。結果發現本樣本平均住院天數59.8天,平均加護病房住院天數39.2天,住院期間血流感染率37.9%,69位存活且出院,8位於出院後30天內再入院。住院期間灌食熱量能達成醫囑量者佔32.2%,7天內為33.3%,平均達成率為0.94(±0.20)。每日攝入32 (±8) Kcal/Kg/day與1.53 (±0.43) g/Kg/day的蛋白質;出院前72.4%個案之體重、72.4%個案之BMI低於入院時;出院前平均白蛋白為3.15(±0.67) g/dL。住院期灌食熱量達成率與血流感染、傷口重複感染及30日再入院無關,但在控制燒傷面積與加護病房入住天數後,能顯著的預測存活(OR=5.32)及出院前白蛋白值達3 g/dL(OR=46.067)。本研究進一步支持積極達成腸道灌食對燒傷病患預後的重要性。醫護人員應積極處置腸道灌食產生的合併症及其他影響因素,達成灌食熱量的需求。
Past evidence supports that high hypermetabolic rate in patients with major burn leads to great losses of protein and negative nitrogen balance and emphasis the importance of aggressive and sufficient nutritional support, such as enteral feeding. The aim of this study was to assess the achievement of enteral feeding and its associations with prognosis factors. A design of cohort study was used and clinical data within the admission for the first burn episode and prognostic status 30 days after discharge was collected via chart review. A total consecutive sample of adults with major burn and having ever receiving enteral feeding were included from a medical center in northern Taiwan. Data was analyzed by using SPSS 20.0. The sample had a mean age of 49.8 and was more in male, and with flame burn, 2-to-3 degree burn or less than 40% burn area. The results revealed there were mean length of stay of 59.8 days, bloodstream infection rate of 37.9%, survival rate of 79.3% and 30-day readmission of 9.1%. During the admission, the mean achieved rate was 0.94(±0.20), and 67.8% of them did not achieve the total desired enteral feeding calorie and 66.6% during the first 7 days. The enteral feeding was able to provide 32(±8) Kcal/Kg and 1.53(±0.43) gm/Kg protein per day. The enteral feeding achieved rate wasn’t associated with bloodstream infection, wound re-infection and 30-day readmission; but it significantly predicted survival (OR=5.32) and the albumin level greater than 3gm/dl upon discharge (OR=46.067). This study demonstrated that the importance of achieving the desired amount of enteral feeding on the prognosis in adult patients with major. Further action is needed to aggressively reduce the obstacles in achieving the desired enteral feeding.
摘 要
ABSTRACT iv
目 次 v
表 次 vii
圖 次 ix
第一章 緒論 1
第一節 研究背景與動機 1
第二節 研究目的 4
第二章 文獻查證 5
第一節 燒燙傷 5
第二節 燒燙傷預後 9
第三節 重症燒傷的營養照護 13
第四節 總結 19
第五節 研究目的與架構 20
第六節 研究問題 21
第七節 名詞解釋 22
第三章 研究方法 24
第一節 研究設計 24
第二節 研究樣本與取樣 26
第三節 研究工具 28
第四節 研究過程 28
第五節 研究倫理考量 29
第六節 資料分析 30
第四章 研究結果 32
第一節 樣本描述 32
第二節 腸道灌食與照護品質成效 35
第三節 腸道灌食達成率 40
第四節 影響營養照謢品質之預測因子 60
第五章 討論 68
第一節 腸道灌食執行狀況與成效 69
第二節 腸道灌食達成率與預後之相關性 71
第六章 結論與建議 78
第一節 結論 78
第二節 建議 81
第三節 研究限制 83
參考文獻 85
中文文獻 85
外文文獻 87
附錄 94
重症燒傷患者腸道灌食達成率與住院照護品質相關性之病歷審查評估表 94

中文文獻
王存福、王先震、張子明(1992).燒傷病人全靜脈營養之併發症.醫學研究,13(2),127-132。
施秉庚、吳肇毅、張家寧、陳信翰(2013).Early Factors for Predicting Mortality Rate in Major Burn Patients--China Medical University Hospital Experiences.臺灣整形外科醫學會雜誌,22(2),117-124。
楊永健、郭月霞(2005).燒燙傷.於楊榮森主編臨床營養學-靜脈暨腸道營養(pp531-542).台北:時新。
楊永健(2010).燒燙傷.於許世祥、楊榮森編著臨床傷口醫學(pp325-347).台北:力大。
趙子傑(2013).實用醫療品質管理學(pp531-542).台北:華杏。
衛生福利部統計處(2013).民國101年主要死因分析,2014年3月22日取自http://www.mohw.gov.tw/cht/DOS/Statistic.aspx?f_list_no=312&fod_list_no=2747
衛生福利部統計處(2013).民國101年死因統計年報,2014年3月22日取自http://www.mohw.gov.tw/cht/DOS/Statistic.aspx?f_list_no=312&fod_list_no=2747
Doherty G. M. (2005).於于大雄編譯華盛頓外科手冊(pp14, 25, 501-512).台北:合記。
周幸生、林玉如、黃意媜、吳麗芬(2003).不同鼻胃管灌食方法對重症呼吸器使用病人照護成效之探討.榮總護理,20(1),1-10。
林秀華、莊寶玉、楊永健(2014).研究早期腸胃灌食對大面積燒傷病人死亡率及血流感染之影響(研究計劃編號NTUH. 101-S1825).台北市:台大醫院。
林晏如、陳玉如、葉玲岑、李靜怡、王秀媛(2011).早期腸道營養對內科重症老人預後之探討.重症醫學雜誌,12(1),1-8。
黃素華、陳珮蓉、張啟仁、賴鴻緒、鄭金寶、劉秀英、楊榮森(2005).住院管灌病患營養狀況及胃腸併發症對營養攝取量之影響.臺灣醫學,9(4),467-474。
黃怡真(2011).不同鼻胃管灌食法對使用呼吸器病患之胃排空及肺吸入的成效:利用統合分析方式檢定.中臺科技大學護理研究所學位論文,1-99。
鍾其祥、劉淳羽、簡戊鑑(2010).臺灣燒燙傷住院傷患之流行病學.北市醫學雜誌,7(1), 53-66。
Yang, W.-G., Yang, J.-Y., Chuang, S.-S., Chang, L.-Y., Tung, T.-C., & Chiang, C.-L. (1998). The Early Nasoduodenal Feeding for the Extensive Burns. 中華民國重建整形外科醫學會雜誌, 7(4), 277-286.
Yu, Y.-C., Huang, H.-F., Lin, Y.-H., Tseng, Y.-Y., Yeong, E.-K., & Chen, M.-T. (2013). Treatment Cost Analysis of Acute Burn Injury. 臺灣整形外科醫學會雜誌, 22(3), 188-198.


外文文獻
Bartlett, R., Dechert, R., Mault, J., Ferguson, S., Kaiser, A., & Erlandson, E. (1982). Measurement of metabolism in multiple organ failure. Surgery, 92(4), 771-779.
Bastow, M. (1986). Complications of enteral nutrition. Gut, 27(Suppl 1), 51-55.
Broughton 2nd, G., Janis, J. E., & Attinger, C. E. (2006). The basic science of wound healing. Plastic and reconstructive surgery, 117(7 Suppl), 12S-34S.
Cataldi-Betcher, E. L., Seltzer, M. H., Slocum, B. A., & Jones, K. W. (1983). Complications occurring during enteral nutrition support: a prospective study. Journal of Parenteral and Enteral Nutrition, 7(6), 546-552.
Colohan, S. M. (2010). Predicting prognosis in thermal burns with associated inhalational injury: a systematic review of prognostic factors in adult burn victims. Journal of Burn Care & Research, 31(4), 529-539.
Cuthbertson, D. (1942). Post-shock metabolic response. The Lancet, 239(6189), 433-437.
De Jonghe, B., Appere-De-Vechi, C., Fournier, M., Tran, B., Merrer, J., Melchior, J.-C., & Outin, H. (2001). A prospective survey of nutritional support practices in intensive care unit patients: what is prescribed? What is delivered? Critical care medicine, 29(1), 8-12.
Demling, R. H. (2005). The incidence and impact of pre-existing protein energy malnutrition on outcome in the elderly burn patient population. Journal of Burn Care & Research, 26(1), 94-100.
Demling, R. H., & Seigne, P. (2000). Metabolic management of patients with severe burns. World journal of surgery, 24(6), 673-680.
Diegelmann, R. F., & Evans, M. C. (2004). Wound healing: an overview of acute, fibrotic and delayed healing. Front Biosci, 9(1), 283-289.
Donabedian, A. (1978). The quality of medical care. Science, 200(4344), 856-864.
Donabedian, A. (1988). The quality of care: How can it be assessed? Jama, 260(12), 1743-1748.
Edelman, D. A., White, M. T., Tyburski, J. G., & Wilson, R. F. (2006). Factors affecting prognosis of inhalation injury. Journal of burn care & research, 27(6), 848-853.
El-Helbawy, R. H., & Ghareeb, F. M. (2011). Inhalation injury as a prognostic factor for mortality in burn patients. Annals of burns and fire disasters, 24(2), 82.
Endo, S., Inada, K., Kikuchi, M., Yamada, Y., Kasoi, T., Kondo, M., ... & Yoshida, M. (1992). Are plasma endotoxin levels related to burn size and prognosis?. Burns, 18(6), 486-489.
Galeiras, R., Lorente, J. A., Pértega, S., Vallejo, A., Tomicic, V., Miguel, A., ... & Esteban, A. (2009). A model for predicting mortality among critically ill burn victims. Burns, 35(2), 201-209.
Gamelli, R. L. (2007). Guidelines for the Operation of Burn Centers. Journal of Burn Care & Research, 28(1), 133.
Germann, G., Barthold, U., Lefering, R., Raff, T., & Hartmann, B. (1997). The impact of risk factors and pre-existing conditions on the mortality of burn patients and the precision of predictive admission-scoring systems. Burns, 23(3), 195-203.
Gosain, A., & Gamelli, R. L. (2005). Role of the gastrointestinal tract in burn sepsis. Journal of Burn Care & Research, 26(1), 85-91.
Gottschlich, M. M., Warden, G. D., Michel, M., Havens, P., Kopcha, R., Jenkins, M., & Alexander, J. W. (1988). Diarrhea in tube-fed burn patients: incidence, etiology, nutritional impact, and prevention. Journal of Parenteral and Enteral Nutrition, 12(4), 338-345.
Guidelines for the operation of burn centers. (2007). J Burn Care Res, 28(1), 134-141. doi: 10.1097/BCR.0b013e31802c8861
Hart, D. W., Wolf, S. E., Chinkes, D. L., Gore, D. C., Mlcak, R. P., Beauford, R. B., . . . Wolfe, R. R. (2000). Determinants of skeletal muscle catabolism after severe burn. Annals of surgery, 232(4), 455.
Herndon, D. N., & Tompkins, R. G. (2004). Support of the metabolic response to burn injury. The Lancet, 363(9424), 1895-1902.
HU, O. Y. P., HO, S. T., WANG, J. J., HO, W., WANG, H. J., & LIN, C. Y. (1993). Evaluation of gastric emptying in severe, burn-injured patients. Critical care medicine, 21(4), 527-531.
Jahoor, F., Desai, M., Herndon, D. N., & Wolfe, R. R. (1988). Dynamics of the protein metabolic response to burn injury. Metabolism, 37(4), 330-337.
Jeschke, M. G., Chinkes, D. L., Finnerty, C. C., Kulp, G., Suman, O. E., Norbury, W. B., . . . Herndon, D. N. (2008). The pathophysiologic response to severe burn injury. Annals of surgery, 248(3), 387.
Jeschke, M. G., Mlcak, R. P., Finnerty, C. C., Norbury, W. B., Gauglitz, G. G., Kulp, G. A., & Herndon, D. N. (2007). Burn size determines the inflammatory and hypermetabolic response. Critical care, 11(4), R90.
Krishnan, J. A., Parce, P. B., Martinez, A., Diette, G. B., & Brower, R. G. (2003). Caloric intake in medical ICU patientsconsistency of care with guidelines and relationship to clinical outcomes. CHEST Journal, 124(1), 297-305.
Kudsk, K. A. (2002). Current aspects of mucosal immunology and its influence by nutrition. The American journal of surgery, 183(4), 390-398.
Kudsk, K. A., Tolley, E. A., DeWitt, R. C., Janu, P. G., Blackwell, A. P., Yeary, S., & King, B. K. (2003). Preoperative albumin and surgical site identify surgical risk for major postoperative complications. Journal of Parenteral and Enteral Nutrition, 27(1), 1-9.
Kyle, U. G., Genton, L., & Pichard, C. (2005). Hospital length of stay and nutritional status. Current Opinion in Clinical Nutrition & Metabolic Care, 8(4), 397-402.
Lam, N. N., Tien, N. G., & Khoa, C. M. (2008). Early enteral feeding for burned patients: an effective method which should be encouraged in developing countries. Burns, 34, 192-196.
Latenser, B. A. (2009). Critical care of the burn patient: the first 48 hours. Critical care medicine, 37(10), 2819-2826.
Laupland, K., Gregson, D. B., Kirkpatrick, A. W., Kortbeek, J. B., Zygun, D. A., Findlay, C., & Hameed, S. M. (2004). Bloodstream infection complicating trauma. Clin Invest Med, 27(5), 253-258.
Lin, C. Y., Wu, C. K., Yeong, E. K., Lin, H. H., Huang, Y. T., Lee, J. K., ... & Tsai, C. T. (2012). Prognostic significance of left ventricular diastolic function in burn patients. Shock, 37(5), 457-462.
Lu, G., Huang, J., Yu, J., Zhu, Y., Cai, L., Gu, Z., & Su, Q. (2011). Influence of early post-burn enteral nutrition on clinical outcomes of patients with extensive burns. Journal of clinical biochemistry and nutrition, 48(3), 222.
Madenci, Ö. Ç., Yakupoğlu, S., Benzonana, N., Yücel, N., Akbaba, D., & Kaptanağası, A. O. (2014). Evaluation of soluble CD14 subtype (presepsin) in burn sepsis. Burns, 40(4), 664-669.
Martin, P. (1997). Wound healing--aiming for perfect skin regeneration. Science, 276(5309), 75-81.
McClave, S. A., Martindale, R. G., Vanek, V. W., McCarthy, M., Roberts, P., Taylor, B., . . . Cresci, G. (2009). ASPEN Board of Directors; American College of Critical Care Medicine; Society of Critical Care Medicine. Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (ASPEN). JPEN J Parenter Enteral Nutr, 33(3), 277-316.
Montejo, J. C. (1999). Enteral nutrition-related gastrointestinal complications in critically ill patients: a multicenter study. Critical care medicine, 27(8), 1447-1453.
Mosier, M. J., Pham, T. N., Klein, M. B., Gibran, N. S., Arnoldo, B. D., Gamelli, R. L., . . . Herndon, D. N. (2011). Early enteral nutrition in burns: compliance with guidelines and associated outcomes in a multicenter study. Journal of burn care & research: official publication of the American Burn Association, 32(1).
Prelack, K., Dylewski, M., & Sheridan, R. L. (2007). Practical guidelines for nutritional management of burn injury and recovery. Burns, 33(1), 14-24.
Prognosis. (n.d.) American Heritage® Dictionary of the English Language, Fifth Edition. (2011). Retrieved August 16 2015 from http://www.thefreedictionary.com/prognosis
Prognosis. (n.d.) psychologydictionary.org. Retrieved August 16 2015 from http://psychologydictionary.org/prognosis
Rodriguez, N. A., Jeschke, M. G., Williams, F. N., Kamolz, L. P., & Herndon, D. N. (2011). Nutrition in burns Galveston contributions. Journal of Parenteral and Enteral Nutrition, 35(6), 704-714. doi: 10.1177/0148607111417446
Rousseau, A.-F., Losser, M.-R., Ichai, C., & Berger, M. M. (2013). ESPEN endorsed recommendations: Nutritional therapy in major burns. Clinical Nutrition, 32(4), 497-502.
Sheridan, R. L., Ryan, C. M., Yin, L. M., Hurley, J., & Tompkins, R. G. (1998). Death in the burn unit: sterile multiple organ failure. Burns, 24(4), 307-311.
Shirani, K. Z., Pruitt Jr, B. A., & Mason Jr, A. D. (1987). The influence of inhalation injury and pneumonia on burn mortality. Annals of surgery, 205(1), 82.
Summer, G. J., Puntillo, K. A., Miaskowski, C., Green, P. G., & Levine, J. D. (2007). Burn injury pain: the continuing challenge. The Journal of Pain, 8(7), 533-548.
Taylor, S. (1999). Early enhanced enteral nutrition in burned patients is associated with fewer infective complications and shorter hospital stay. Journal of Human Nutrition and Dietetics, 12(2), 85-91.
Tintinalli, J. E., Krome, R. L., & Ruiz, E. (1992). Emergency Medicine: A Comprehensive Study Guide. Advanced Emergency Nursing Journal, 14(3), 74.
Vanni, H. E. C., Gordon, B. R., Levine, D. M., Sloan, B. J., Stein, D. R., Yurt, R. W., ... & Parker, T. S. (2003). Cholesterol and interkeukin-6 concentrations relate to outcomes in burn-injured patients. Journal of Burn Care & Research, 24(3), 133-141.
Wasiak, J., Cleland, H., & Jeffery, R. (2007). Early versus late enteral nutritional support in adults with burn injury: a systematic review. Journal of Human Nutrition and Dietetics, 20(2), 75-83.
Watterson, D., Cleland, H., Picton, N., Simpson, P. M., & Gabbe, B. J. (2011). Professional practice and innovation: Level of agreement between coding sources of percentage total body surface area burnt (% TBSA). Health Information Management Journal, 40(1), 21.
Wolf, S. E. (2007). Critical care in the severely burned: organ support and management of complications. Total burn care. 3rd ed. London: Saunders Elsevier, 454-476.
Wolfe, R. R., Durkot, M. J., Allsop, J. R., & Burke, J. F. (1979). Glucose metabolism in severely burned patients. Metabolism, 28(10), 1031-1039.
World Health Organization (2006). Quality of Care: A process for making strategic choices in health systems. Retrieved May 1, 2014, from http://www.who.int/management/quality/assurance/QualityCare_B.Def.pdf
Yang, H. T., Yim, H., Cho, Y. S., Kim, D., Hur, J., Chun, W., ... & Lee, J. J. (2011). Investigation of relationship between inhalation injury assessment and prognosis in burn patients. Journal of the Korean Surgical Society, 81(1), 1-9.
Yu, Y.-M., Tompkins, R. G., Ryan, C. M., & Young, V. R. (1999). The metabolic basis of the increase in energy expenditure in severely burned patients. Journal of Parenteral and Enteral Nutrition, 23(3), 160-168.

QRCODE
 
 
 
 
 
                                                                                                                                                                                                                                                                                                                                                                                                               
第一頁 上一頁 下一頁 最後一頁 top
無相關論文