臺灣博碩士論文加值系統

背景：尿布性皮膚炎為嬰幼兒最常見的皮膚問題，因皮膚表面接觸到刺激物(如大小便等)所造成的皮膚炎症反應，其危險因子主要為潮濕、大小便持續接觸會陰部至臀部與肛門周圍，易形成發紅、起小疹子等為接觸性皮膚炎反應。受傷的皮膚角質層通常比健康皮膚之水分散失量值高，因此，倘若嬰兒發生紅臀時，其水分散失量值可能更高。將患處暴露於空氣中，使用烤燈作為輔助療法時，其皮膚水分散失量值可能流失快速而影響皮膚癒合。
目的：探討不同介入措施於嬰兒尿布性皮膚炎之體溫散失、尿布性皮膚炎與水分散失量之成效。
方法：本研究為實驗性研究，研究對象為某南部醫學中心新生兒中重度病房之出生1歲內發生1級以上紅臀之嬰兒。採入院順序隨機分派。隨機分派成三組，以編號1、4、7、10、13、16…70為實驗組A：烤燈輔助+聚乙烯膜(Polyethylene, PE)覆蓋床邊兩側；2、5、8、11、14、17…71為實驗組B：烤燈輔助；3、6、9、12、15、18…72為對照組：僅通風乾燥，共預計收案72人，每組24人，介入時間為一天3次，共3天，若於執行期內即癒合，即結束介入措施，並記錄時間執行時間。
結果：三組在體溫的部分，不論在介入措施前、後，維持於36.68~36.78℃。三組平均於介入措施後第6.85±1.34次可改善，介入措施次數無顯著差異(P=0.091)。介入天數三組平均於介入後第2.74±0.44天可改善，呈現顯著差異(P=0.046)；三組比較實驗組A平均2.63(SD±0.49)天>對照組平均2.67(SD±0.48)天>實驗組B平均2.92(SD±0.28)天。以LSD事後檢定比較顯示實驗組A較實驗組B之介入天數少0.29天，有顯著差異（p=0.022）；對照組較實驗組B之介入天數少0.25天，有顯著差異（p=0.048）；而實驗組A與對照組之間無顯著差異（p=0.738）。以廣義估計式(Generalized estimating equations, GEE)以類別方式0、1、2、3級分析三組在介入措施後尿布性皮膚炎癒合等級皆無顯著差異。三組水分散失值的前測實驗組A平均28.37(SD±13.00g/m²h)；實驗組B 平均23.01(SD±9.76g/m²h)；對照組平均27.46(SD±15.61g/m²h)，三組TEWL在前測無顯著差異（p=0.162)。其水分散失值後測為實驗組A平均20.65(SD±5.29)g/m²h；實驗組B平均21.85(SD±10.85)g/m²h；對照組平均20.34(SD±5.45g/m²h)，三組後測沒有顯著差異（p=0.773)。以GEE方式分析介入前(T0)、及第1~第9次經皮水分散失量(TEWL)，介入措施後比介入前的經皮水分散失(TEWL )減少。分析實驗組A與對照組研究結果沒有顯著差異(β=-4.56、P=0.470)。實驗組B與對照組研究結果發現有顯著差異(β=-11.36、P=0.042)。在T1、T2、T3、T4、T5、T7有顯著差異，其數值為使用烤燈照護對於皮膚水分較容易散失。聚乙烯(Polyethylene, PE)膜對於水分散失值具有防止水分蒸發、具有保溫效果，但對於尿布性皮膚炎照護無統計上意義。
結論: 減少維持經皮水分散失量(TEWL)以增加皮膚足夠的水合作用，促使皮膚角質層修復，改善紅臀癒合。採用自然通風乾燥對尿布性皮膚炎為最佳照護方式，且為最經濟實惠之方式，結果可在未來建立預防嬰兒尿布性皮膚炎的臨床照護時提供重要參考。
實務運用：本研究結果顯示以固定時間暴露於空氣中能改善尿布性皮膚炎、降低經皮水分散失量(TEWL)，可有效預防尿布性皮膚炎的護理。未來若有家屬要求須使用烤燈照護時，則建議可使用烤燈照護+PE膜覆蓋在床旁兩側，減少因紅臀經皮水分散失量(TEWL)，以利皮膚有足夠的水合作用，促使皮膚角質層修復，改善尿布性皮膚炎癒合，為提供其護理。

Background：Diaper dermatitis is the most common skin problem for infants and children because of the reactions caused by the irritants with skin surface contact, and the risk factors are moist and constantly contact the perineum to buttocks and around the anus and they are easily to cause skin reactions such as redness and rashes. The water loss value for the wounded skin stratum corneum is usually higher than the healthy skin, therefore when the diaper dermatitis occurred; the water loss value is even higher. When the affected area is exposed to the air and used as an adjunct therapy, the water loss value of the skin may be lost rapidly and affect the skin healing.
Purpose:To explore the e effectiveness on body temperature , diaper dermatitis and water loss in different intervention among infants with diaper dermatitis.
Method：This study was a randomized controlled trial of infants enrolled at one year of birth with grade 1 and above diaper dermatitis in the Complete Nursing Unit (CNU) of a Southern Medical Center. The participants were randomly assigned to the order of admission. This study randomized into three groups with 24 participants in each group. With numbers 1, 4, 7, 10, 13, and16, …70 were experimental group A：heating lamp auxiliary + polyethylene film (Polyethylene, PE) covering both sides of the bed; with numbers 2, 5, 8, 11, 14, and 17 , …71 were experimental group B：assisted by heating lamps;3, 6, 9, 12, 15 and 18,…72 were control groups：only ventilated and dried. A total of 72 infants were included in this study. Each way we spend 3 times per day in every group. Once time is 30 minutes. And every group keeps this way for 3 days.
Result：The body temperature of the three groups was maintained at 36.68–36.78°C prior and posts the intervention. The average of the three groups was improved at 6.85±1.34 times after intervention, and there was no significant difference in the frequency of interventions (P=0.091).The average number of intervention days in the three groups could be improved on the 2.74±0.44th day after intervention and also showing a significant difference (P=0.046). The average of 2.63 (SD±0.49) days in the experimental group A was greater than the average 2.67 (SD±0.48) days in the control group, and then the control group was greater than 2.92 (SD±0.28) days in the experimental group B. The LSD post hoc comparison showed that the intervention days of experimental group A were 0.29 days less than that of experimental group B, with a significant difference (p=0.022) ; and there was no significant difference between the experimental group A and the control group (p=0.738). There was no significant difference in the healing grade of diaper dermatitis after the intervention among the three groups by the generalized estimating equations (GEE) analysis of 0, 1, 2, and 3 categories. The pre-test of the three groups of water loss values was 28.37 (SD±13.00g/m²h) in experimental group A; 23.01 (SD±9.76g/m²h) in experimental group B; 27.46 (SD±15.61g/m²h) in the control group. There was no significant difference in TEWL between the three groups in the pretest (p=0.162). The water loss value of experimental group A was 20.65 (SD±5.29g/m²h) on average; experimental group B was 21.85 (SD±10.85g/m²h); the control group was 20.34 (SD±5.45g/m²h). There was no significant difference (p=0.773). The pre-intervention (T0) and the 1st to 9th transcutaneous water loss (TEWL) were analyzed by GEE, and the transcutaneous water loss (TEWL) after the intervention was lower than that before the intervention. There was no significant difference between the experimental group A and the control group (β=-4.56, P=0.470). There was a significant difference between the experimental group B and the control group (β=-11.36, P=0.042). There are significant differences in T1, T2, T3, T4, T5, and T7, and the value is that the skin moisture is easier to lose when using the heating lamp. Polyethylene (PE) film has the effect of preventing water evaporation and thermal insulation for the water loss value, but it has no statistical significance for the care of diaper dermatitis.
Conclusion：Reduction of maintenance trans-epidermal water loss (TEWL) increases sufficient skin hydration, promotes skin stratum corneum repair, and improves diaper dermatitis healing. The use of natural ventilation and drying is the best way of care for diaper dermatitis, and it is the most economical way, and the results can provide an important reference for the establishment of clinical care for the prevention of diaper dermatitis in infants in the future.
Clinical Practice: The results show that exposure to air for a regular time can improve diaper dermatitis, reduce trans-epidermal water loss (TEWL) and can effectively prevent diaper dermatitis. In the future, if there is a family member who requires using a heating lamp for care, it is recommended to use the heating lamp and PE film to cover both sides of the bed to reduce the trans-epidermal water loss (TEWL) caused by diaper dermatitis, so that the skin is sufficiently hydrated. Additionally, it promotes the repair of the stratum corneum of the skin, improves the healing of diaper dermatitis and provides the cares.

目次
摘要 I
ABSTRACT V
致謝 IX
圖表目錄 XI
目次 XII
第一章、 緒論 1
第一節、問題背景及重要性 1
第二節、問題陳述 4
第三節、研究目的 5
第四節、研究假設 6
第二章、文獻查證 7
第一節、嬰兒尿布性皮膚炎 7
第二節、嬰兒尿布性皮膚炎照護與體溫散失之相關性 17
第三節、嬰兒尿布性皮膚炎與經表皮水分流失之相關性 20
第四節、研究架構 27
第五節、名詞定義 28
第三章、研究方法 32
第一節、研究設計 32
第二節、研究樣本與取樣 33
第三節、研究步驟與資料收集過程 34
第四節、研究工具及信效度 38
第五節、資料蒐集過程 44
第六節、研究倫理 45
第七節、資料分析與統計 47
第四章、研究結果 48
第一節、研究對象之基本資料分析(N=72) 48
第二節、在體溫的部分 51
第三節、在尿布性皮膚炎部分 52
第四節、在水分散失部分 56
第五章、討論 61
第一節、介入措施前、後體溫之探討 61
第二節、尿布性皮膚炎之探討 63
第三節、尿布性皮膚炎之水分散失探討 65
第六章、結論與建議 68
第一節、綜合重要研究發現 68
第二節、在護理實務教育上的意涵或應用 70
第三節、研究限制 71
第四節、未來研究方向 72
參考文獻 73
中文摘要 73
英文摘要 74
附件一、同意書 93
附件二、人體試驗委員會同意書 94
附件三、人口學基本屬性表 95
附件四、嬰兒尿布性皮膚炎照護登錄表 98

中文摘要
伍雁鈴、程子芸、蕭慧玲、高淑雰（2021）．兒童皮膚系統疾病及其護理．於陳月枝總校閱，實用兒科護理（九版一刷，887-922頁）．華杏。
林元淑（2021）．新生兒及其護理．於陳月枝總校閱．實用兒科護理學（九版一刷，82頁）．華杏。
邱淑玲、謝珮琳（2018）‧冷熱療法的護理‧於蘇麗智、簡淑真、劉波兒編著 ‧ 基本護理學（下冊，2-50 頁）‧華杏。
陳柏渝(2021)·新生兒尿布性皮膚炎實證照護指引發展與適用性評值 [未發表之博士論文]．國立成功大學護理學系。
陳恩惠 (2017) ‧產後護理之家新生兒尿布性皮膚炎危險因子的調查[未發表之碩士論文]．中臺科技大學護理研究所。
陳恩惠、林寀涵、涂嘉玲(2018) ‧新生兒尿布性皮膚炎危險因子的調查‧助產雜誌，60，12-21。
曾虹齡、張淑華、趙麗玫、李愛誠、李秋香（2011）．降低某加護單位病患發生瀉性皮膚炎之專案．中山醫學雜誌，22（3），387-398。
黃靜微（2011）．高危險新生兒．於蔣立綺等編著，兒科護理學（八版，74-80頁）．永大。
塗嘉玲(2016) ‧比較不同坐月子地點之產後婦女育母自信覺知與差異性探討壓力[未發表之碩士論文]．國立台北護理研究所。
新北市護理師公會（2019）．嬰兒尿布疹的照護(108 年版)．取自 http://www.ttcna.org.tw/filecenter/B/8D6A6519F31AC3A053/13%e5%b0%bf%e5%b8%83%e7% 96%b9-%e5%b0%88.pdf
劉嘉惠、謝伶瑜、林姿佳(2014)‧以聚乙稀製品包覆早產兒身體對於預防失溫之成效．台灣醫學18，598-605。DOI: lO,6320/FJM,2014.l 8(5).14
衛生署對於國內嬰幼兒年齡的界定(2022，03月30日)．小兒年齡分期．https://twwiki.net/wiki/nwvqnnjqr9ol3e6.html
盧虹如、陳詠如、柯雅芳（2017）．一位失禁性皮膚炎幼童之照護經驗．護理雜誌，64（6），112-118。
英文摘要
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