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研究生:林慧茹
研究生(外文):Hui-Ru Lin
論文名稱:外科加護病房術後病人晚期拔管及 住院天數相關因素之探討
論文名稱(外文):Factors Related to Late Extubation and Length of Hospital Stays of Postoperative Patients in Surgical Intensive Care Unit
指導教授:謝亞倫謝亞倫引用關係
指導教授(外文):Ya-Lun Hsieh
學位類別:碩士
校院名稱:美和科技大學
系所名稱:護理系健康照護碩士班
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:2020
畢業學年度:108
語文別:中文
論文頁數:91
中文關鍵詞:外科加護病房晚期拔管住院天數累積輸出及輸入餘量
外文關鍵詞:Surgical Intensive Care UnitDelay ExtubationLength of Hospital StaysCumulative Fluid Balance
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中文摘要
本研究旨在探討外科加護病房術後病人晚期拔管及住院天數的相關因素探討。採回溯性研究法,以某區域教學醫院的外科加護病房術後病人為研究對象,於2018年03月至2018年06月,收集年齡大於20歲,且有氣管經喉插管並使用呼吸器者,共收案204名。研究資料以SPSS 23.0 for Windows/PC套裝軟體進行描述性統計、獨立樣本 t檢定、卡方檢定、邏輯式迴歸與線性迴歸分析。
研究結果顯示:描述性統計方面(男:137人、女:33人),平均年齡為65.44(±14.17)歲,平均拔管時數為50.95 (SD±77.04)小時,平均住院天數為4.96(SD±4.13)天。
晚期拔管之單變項分析顯示:APACH II(p<0.015)、血紅素(p<0.035)、鈣離子(p<0.049)、淺快呼吸指數(p<0.001)、最大吸氣壓力(p<0.001)、累積輸出入餘量(p<0.003)、住院天數(p<0.001)與晚期拔管有關。將上述具有顯著性之變項放入邏輯式迴歸分析,顯示累積輸出入餘量與晚期拔管有關(OR=1.005)(95% CI 1.000-1.009)。
住院天數之單變項線性迴歸分析顯示:血紅素(p<0.013)、淺快呼吸指數(p<0.001)、最大吸氣壓力(p<0.001)、累積輸出入餘量(p<0.001)、術後尿素氮(p<0.002)、住院天數(p<0.001)與住院天數有關。將上述具有顯著性之變項放入多元迴歸分析,顯示:(1)淺快呼吸指數值每增加一個breaths/min/L,住院天數就會增加0.116天(p=0.001);(2)拔管天數每增加一天,住院天數就會增加0.495天(p=0.005)。
Factors Related to Late Extubation and Length of Hospital Stays of Postoperative Patients in Surgical Intensive Care Unit

Abstract
This study aims to investigate the factors related to delayed extubation and length of hospital stay in postoperative patients in surgical intensive care units (ICUs). A retrospective study was conducted with postoperative patients in the surgical ICU of a regional teaching hospital as research subjects. A total of 204 patients aged over 20 years who received ventilation with orotracheal intubation from March 2018 to June 2018 were included in this study. Descriptive statistics, independent-samples t-test, the chi-square test, and logistic and linear regression analyses were performed on the study data using SPSS 23.0 for Windows/PC software package.

Results: Regarding descriptive statistics, 137 male and 33 female patients were included in the analysis, with a mean (±standard deviation [SD]) age of 65.44 (±14.17) years. Their mean (±SD) time to extubation was 50.95 (±77.04) hours, and the mean length of hospital stay was 4.96 (±4.13) days.

Univariate analysis regarding delayed extubation revealed that the Acute Physiology and Chronic Health Evaluation II (APACHE II) score (p<0.015), heme level (p<0.035), calcium level (p<0.049), rapid shallow breathing index (p<0.001), maximum inspiratory pressure (p<0.001), cumulative fluid balance (p<0.003), and length of hospital stay (p<0.001) were correlated with delayed extubation. Logistic regression analysis of the above significant variables showed that cumulative fluid balance was related to delayed extubation (odds ratio [OR]=1.005; 95% confidence interval [CI]: 1.000-1.009).

On univariate linear regression analysis, the length of hospital stay was correlated with heme level (p<0.013), rapid shallow breathing index (p<0.001), maximal inspiratory pressure (p<0.001), cumulative fluid balance (p<0.001), postoperative urea nitrogen (p<0.002), and length of hospital stay (p<0.001). Multivariate regression analysis of the above significant variables showed that (1) each breaths/min/L increase in rapid shallow breathing index was associated with a 0.116-day increase in hospital stay (p=0.001); (2) each 1-day increase in time to extubation was associated with a 0.495-day increase in hospital stay (p=0.005).
目錄
論文口試委員會審定書 i
致謝 ii
中文摘要 iii
英文摘要 v
目錄 vii
圖表目錄 viii
第一章 緒論 1
第一節 研究動機 1
第二節 研究目的 3
第三節 研究假說 4
第二章 文獻查證 5
第一節 術後病人氣管內管置入原因及目的 5
第二節 影響晚期拔管之相關因素 9
第三節 晚期拔管對病人的影響 22
第三章 研究方法 27
第一節 研究概念架構 27
第二節 名詞界定 29
第三節 研究場所及對象 33
第四節 研究工具 34
第五節 資料收集過程 36
第六節 資料分析與統計方法 36
第七節 倫理考量 40
第四章 研究結果 41
第一節 研究對象基本屬性分佈 41
第二節 各項探討指標與晚期拔管之分佈情形 44
第三節 晚期拔管之相關因素探討 48
第四節 晚期拔管與住院天數之關係 52
第五章 討論 57
第一節人口學特性與晚期拔管之差異 57
第二節疾病特性與晚期拔管之差異 57
第三節術前檢驗值術後生理指標與晚期拔管之差異 58
第四節呼吸器脫離指標與晚期拔管之關係 61
第五節術後代謝指標與晚期拔管之關係 63
第六節術後病人晚期拔管之預測因子 64
第七節 早期或晚期拔管與住院天數之比較 66
第六章 結論與建議 69
第一節 結論 69
第二節 研究限制 70
第三節 應用與建議 71
中文參考文獻 73
英文參考文獻 79
圖表目錄
圖3-1 研究架構 28
表2-1輸出入餘量與晚期拔管之關係近五年研究整理 18
表2-2住院天數與晚期拔管之關係近五年文獻整理 20
表3-1研究變項取得方式 35
表3-2描述性統計分析方法 37
表3-3推論性統計分析方法 38
表4-1研究對象之基本屬性 42
表4-2各項探討指標與晚期拔管之分佈情形 46
表4-3影響晚期拔管之因素(單變項) 49
表4-4影響晚期拔管之因素(多變項) 50
表4-5影響住院天數之因素(單變項) 52
表4-6影響住院天數之因素(多變項) 54
表4-7研究假說之驗證結果 56
表5-1查檢表 68
附錄一、人體試驗計畫同意函 91
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