臺灣博碩士論文加值系統

褥瘡有提高其他併發症的風險。以微循環和褥瘡的關係研究中，較少對於皮膚微循環的連續觀察。本研究假設五周間，三個群組之間：臥床無褥瘡患者 (臥床組)、傷口癒合(癒合組)與惡化狀態(惡化組)，骶骨軟組織的皮膚微循環是否會有差異。目的希望藉由了解在在五周內，不同受試者之間微循環變化。本研究方法是以反應性充血檢測骶骨軟組織的皮膚微循環。受測者首先進行3分鐘一般血流狀態監測後，再施加200mmHg之壓力5分鐘，最後釋放壓力後持續監測4分鐘。本研究數據有[1]Braden 量表；[2]皮膚水、油份；[3]反應性充血前後最高皮膚微循環量比值(充血比值)；[4]反應性充血前後皮膚微循環量積分比值(積分比值)。結果在五周內的三次比較中，充血比值與積分比值皆不具有統計上顯著差異。在潰瘍與血流相關性，癒合組潰瘍變化與充血比值的相關係數，為0.85呈現統計上顯著相關。表示對於癒合組，微循環血管的瞬間收縮程度可作為對潰瘍變化的觀察。惡化組則在潰瘍大小變化與充血比值、積分比值相關性表現分別為 -0.09與-0.10不具顯著相關。不能以微循環參數作為對於傷口程度的觀察項目。

Pressure ulcers can increase the risk of other complications. In the study of the relationship between microcirculation and pressure ulcers, there is less continuous observation of skin microcirculation in bedsores patients. The hypotheses of this study were that in the three group, the bedridden with pressure ulcer healing (healing group), bedridden with pressure ulcer worsening (worsening group),and bedridden without pressure ulcer (bed group), the microcirculation will be different, and it will be related with change in ulcer size of pressure ulcers. The purpose is to observe the observation of reactive hyperemia after occlusion, to understand the five-week microcirculation changes, to compare the differences in microcirculation among different groups, and to explore the correlation between the assessment parameters. The post occlusive reactive hyperemia (PORH) was measured with a laser Doppler flow meter. After 3 minutes of general blood flow monitoring was performed on the skin of the sacrum, a pressure of 200 mmHg was applied for 5 minutes. After the release of pressure, the reaction perfusion was continued for 4 minutes . The parameters in this study were [1] Braden Scale [2] skin water and oil [3] ratio of maximum skin microcirculation before and after reactive hyperemia (hyperemia ratio) [4] ratio of skin microcirculation before and after reactive hyperemia (Integral ratio). The results of this study were no significant differences between the hyperemia ratio and the integral ratio in three consecutive biweekly comparisons. In the relation between ulcer and blood flow, the correlation coefficient between the ulcer change and the hyperemia ratio of ulcer healing was significantly correlated with 0.85. This indicates that the degree of instantaneous contraction of the microcirculatory wall in ulcer healing patients can be used as an observation of ulcer changes. There was no significant correlation is -0.09 and -0.10 for the worsening group between the ulcer size change and the blood flow hyperemia ratio and the correlation ratio of the integral ratios. In worsening gorup, microcirculation parameters cannot be used as an observation item for the degree of wound.

目錄
謝誌 6
摘要 7
壹、前言 9
1-1. 褥瘡現況 9
1-2. 褥瘡原因 10
1-3. 褥瘡評估與預防 11
1-4. 微循環與傷口 14
1-5. 老化對皮膚微循環的影響 15
1-6. 假設與目的 16
貳、研究方法 17
2-1. 研究對象 17
2-2. 研究流程 19
2-3. 儀器與設備 20
2-4. 資料量測 24
2-5. 閉塞後反應性充血 28
2-6. 血流數據 30
2-7. 統計 31
參、結果 32
3-1. 基本資料 32
3-2. 五周微循環變化 32
3-3. 三組受測者間之差異 36
3-4. 各項評估項目間相關性 39
肆、討論 42
4-1. 五周微循環變化討論 42
4-2. 各分組間微循環討論 42
4-3. 各分組間參數相關性討論 43
4-4. 水分、油份與血流的探討 44
4-5. Braden量表討論 45
4-6. 吉尼係數用於評估之可能性 45
4-7. 實驗限制 46
4-8. 未來工作 47
伍、結論 48
參考文獻 49
附錄 53
附錄一、Braden量表評分標準 53
附錄二、整體測試流程 54
附錄三、Matlab數據分析程式碼 55
附錄四、實驗注意事項 67
附錄五、一般人基本資料 67
附錄六、含一般人之分析表 68
附錄七、受試者同意書 73

表目錄
表1. 褥瘡風險評估表比較 12
表2. Braden Scale活動評量積分量表 13
表3. 研究前後樣本數 18
表4. 臥床者基本資料 32
表5. 血流、潰瘍、水分三次連續雙周比較 33
表6. 血流、潰瘍、水分三次連續雙周比較之P-value 33
表7. 三組間微循環、水油、Braden參數平均與顯著性 36
表8. 各項評估項目間相關性 39
表9. Braden量表 53

圖目錄
圖1. 骶骨位置 11
圖2. 研究流程 19
圖3. 都卜勒血流計 20
圖4. 固定後探頭 21
圖5. 都卜勒探頭固定外殼結構 21
圖6. 機台示意 22
圖7. 實際測驗 22
圖8. 機台實體 23
圖9. 皮膚水分測試儀 24
圖10. 比例尺與潰瘍選取範例 25
圖11. 比例尺與潰瘍之數據範例 25
圖12. PORH流程 27
圖13. PORH示意 29
圖14. 皮膚微循環資料示意 30
圖15. 反應性充血前後最高皮膚微循環量比值趨勢 34
圖16. 反應性充血前後皮膚微循環量積分比值 35
圖17. 潰瘍連續三次雙周間大小變化 35
圖18. 血流參數差異圖 37
圖19. 水分、油分血流差異圖 38
圖20. Braden量表 39
圖21. 潰瘍變化圖 41
圖22. 步驟流程圖 54
圖23. 含一般人血流參數差異圖 69
圖24. 含一般人之水分、油分差異圖 70

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