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研究生:黃佳琳
研究生(外文):Huang, Chia-Lin
論文名稱:術中低體溫危險因素之探討-以中部某醫學中心為例
論文名稱(外文):Analysis of risk factors for intraoperative hypothermia -a case study of a medical center in central Taiwan
指導教授:潘忠煜潘忠煜引用關係
指導教授(外文):Pan, Chung-Yu
口試委員:陳南松莊秀文潘忠煜
口試委員(外文):Chen, Nan-SongChuang, Sheu-WenPan, Chung-Yu
口試日期:2021-04-25
學位類別:碩士
校院名稱:東海大學
系所名稱:工業工程與經營資訊學系
學門:工程學門
學類:工業工程學類
論文種類:學術論文
論文出版年:2021
畢業學年度:109
語文別:中文
論文頁數:61
中文關鍵詞:非預期性低體溫術中低體溫原因
外文關鍵詞:Inadvertent perioperative hypothermiahypothermia in operation
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背景與目的:研究顯示每年約有50%~90%的病人會發生手術中非預期性低體溫的情形,是常見且嚴重的合併症之一,為了提升病人手術全期的醫療品質,體溫的維持也是不可或缺的因素之一,本研究目的主要為分析過去病人在手術過程中,造成低體溫的影響因素。
方法:本研究採回溯性研究方式,對象為中部某醫學中心接受手術及麻醉的病人,隨機取樣2019年5月份的電子麻醉紀錄,排除進入手術室的第一筆體溫、手術結束前30分鐘體溫、麻醉結束後15分鐘體溫所遺失與不完整的資料及排除小於18歲的病人,所得到的樣本數為1522位,再從1522位中篩選出第一筆測量到的體溫為大於36度的個案共789人,分析其造成手術中低體溫的原因。由電子麻醉紀錄中獲得病人手術中的相關資訊,如:年齡、性別、身體質量指數、麻醉方式、輸液加溫管路、靜脈輸液量及每小時體溫…等,藉由以上資料當作研究變項,研究工具以Excel建檔分類,採用SPSS for Window 22.0之統計軟體,運用獨立T檢定(independent t-test)、卡方檢定(Chi-square)等統計方法,進行描述性及推論性統計分析。
結果:研究結果顯示在年齡、體重、身體質量指數、傳統開腹手術或內視鏡手術、麻醉分類、麻醉方式、輸液加溫管路、靜脈輸液量、第一筆體溫、手術中每小時的體溫及手術結束前30分鐘體溫,以上皆有統計上的差異。
結論:病人在手術室第一次測量到的體溫數值,也就是病人本身的體溫,對於手術期間體溫的維持是很重要的因素之一,從入手術室第一次測量到的體溫至手術中第二小時,這段期間是體溫下降最快的時間點,可在病人進入手術室前積極給予保暖措施,對於手術中病人的保溫效果及在恢復室體溫的維持,可增加術後的舒適度及預防低體溫所造成的相關合併症,在臨床運用上,病人在未接受麻醉前,預先給病人主動式加溫預熱(pre-warming)的護理措施來提高病人的體溫,有助於病人手術全期體溫的恆定,本研究結果可作為未來病人照護的參考依據。

Background: Inadvertent perioperative hypothermia(IPH) is a common but severe complication during operation, occurring in about 50 to 90% patients each year. In order to improve the quality of patient care, therefore, it is crucial to maintain body temperature (BT) during surgery. Our study was to analysis the factors affecting hypothermia in operation.
Methods: Our study was a retrospective study for patients who underwent an operation during one month in 2019 in a medical center in Taichung. The electronic medical records of 789 patients were reviewed. Variables included age, gender, body mass index, analgesic method, intravenous infusion volume, and hourly BT. We used independent t-test and chi-square for statistics analysis.
Result:We found out that there were significant differences in age, body weight, body mass index, operation method, analgesic method, intravenous infusion volume, initial BT, hourly BT during operation and BT taken 30 minutes before the operation ends.
Conclusions: The initial BT was an important factor for maintaining BT during surgery. Most BT drop occurred in the first 2 hours of operation. Keeping the patient’s BT before entering the operation room helped to maintain BT during and after operation, increase patient comfort and prevent hypothermia. It was advised to use pre-warming facilities for BT control.

摘要i
ABSTRACTii
目錄iii
表目錄v
圖目錄vi
第一章 緒論1
1.1研究背景與動機1
1.2研究目的1
1.3研究流程2
第二章 文獻探討3
2.1人體體溫恆定3
2.2身體熱能流失的過程6
2.3核心體溫變化三階段8
2.4低體溫對人體造成的影響11
2.5造成非預期性低體溫的相關因素15
2.6術前加溫措施與體溫的相關研究20
2.7預防手術圍期低體溫的措施與策略23
第三章 研究方法28
3.1研究對象及架構28
3.2研究工具及變項28
3.3變項定義與測量30
第四章 研究結果與討論33
4.1研究對象基本屬性分布比較33
4.2研究對象手術中影響體溫之因素之比較37
4.3研究對象手術中體溫之變化41
4.4討論43
第五章 結論、建議與限制45
5.1結論與建議45
5.2研究限制46
參考文獻47
中文文獻47
英文文獻48



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