臺灣博碩士論文加值系統

加護病房譫妄是重症病人實質上的臨床問題之一，易受傷害性是指個體對實際或潛在壓力源的易感性，而壓力可能會影響病人，造成不良後果。
本研究旨在探討心血管加護病房病人易受傷害性與譫妄發生之關係及其相關因素。
此研究採橫斷式觀察性研究設計，以北區某醫學中心心血管加護病房之病人為研究對象，自111年01月1日到111年6月30日採方便選樣共收取139位參與者，研究工具包含基本屬性 (人口學變項及疾病特性)、易受傷害性問卷、身體功能狀態評估、壓力知覺問卷、憂慮度問卷、認知功能測量，輔以每日譫妄評估，所收集資料應用IBM SPSS Statistics 22.0版電腦統計軟體，以邏輯斯回歸分析驗證預測因素。
研究結果顯示心血管加護病房病人譫妄發生率為66.2%，易受傷害性程度每增加1分，可增加1.728倍的譫妄發作機率 (95%信賴區間CI: 1.406 - 2.124)，易受傷害性、認知功能、身體功能狀態、壓力知覺及憂慮度因素解釋譫妄百分之51.4的總變異量，可視為加護病房譫妄發作的預測因子。
此研究結果可作為護理人員進行評估譫妄之參考，可以易受傷害性作預測性評估以概括病人的基本態勢。

Delirium in the intensive care unit is a significant clinical problem for critically ill patients. Vulnerability refers to the individual's susceptibility to actual or potential stressors. Stress may affect patients and cause undesirable consequences.
This study aimed to investigate the relationships between vulnerability and delirium and related factors of patients in the cardiovascular intensive care unit.
The research adopted a cross-sectional observational research design. The 139 patients were recruited from a cardiovascular intensive care unit of a medical center in the New Taipei City using convenient sampling. Research instruments including basic properties (demographics and disease characteristics), vulnerability questionnaire (Vulnerable Elders Survey-13), Karnofsky performance scale, Perceived Stress Scale, Patient Health Questionnaire, and cognitive function measurement (Mini-cog) supplemented by Intensive Care Delirium Screening Checklist were used for data collection. The collected data was analyzed by SPSS for window 22.0 statistics and by logistic regression analysis to verify the predictors.
The findings revealed that the incidence of delirium in the cardiovascular intensive care unit was 66.2%. Logistic regression analysis showed that patients with a high degree of vulnerability have a higher incidence than those with a low degree of it (OR:1.728, CI: 1.406 - 2.124). The total variance in delirium is 51.4 percent, explained by VES-13, KPS, PSS-10, PHQ-9, and Mini-cog.
The findings of this study will be used as the reference for nursing staff in assessing delirium. The vulnerability assessment may be a predictive assessment to generalize patient's basic situation.

目錄
誌謝 I
表目錄 V
圖目錄 VI
中文摘要 VII
英文摘要 IX
第一章 緒論 1
第一節 研究背景與重要性 1
第二節 研究目的 4
第二章 文獻查證 5
第一節 譫妄相關概念 5
第二節 易受傷害性之相關概念 23
第三節 易受傷害性與譫妄之關係及其相關因素之相關研究 32
第三章 研究方法 42
第一節 研究設計 42
第二節 研究問題與研究假設 43
第三節 名詞定義 44
第四節 研究場所及對象 46
第五節 研究工具 47
第六節 研究步驟 59
第七節 資料統計分析 60
第八節 倫理考量 62
第四章 研究結果 63
第一節 心血管加護病房病人基本屬性之分布。 63
第二節 心血管加護病房人易受傷害性、身體活動功能、
心理傾向、認知功能與譫妄變項之分佈 72
第三節 心血管加護病房病人之基本屬性、易受傷害性、
身體活動功能、心理傾向、認知功能與譫妄變項的關係 76
第四節 心血管加護病房病人譫妄之重要預測因子 90
第五章 討論 96
第一節 心血管加護病房病人口學變項、疾病特性、
身體功能狀態、心理與認知反應與譫妄之關係 96
第二節 心血管加護病房病人易受傷害性與譫妄之關係 100
第六章 結論與建議 104
第一節 結論 104
第二節 研究限制 104
第三節 研究建議 105
參考資料 108
附件 125
附件一 人體試驗/研究許可書 125

Abernethy, A. P., Shelby-James, T., Fazekas, B. S., Woods, D., & Currow, D. C. (2005). The Australia-modified Karnofsky Performance Status (AKPS) scale: a revised scale for contemporary palliative care clinical practice [ISRCTN81117481]. BMC palliative care, 4(1), 1-12.
Ahmed, S., Leurent, B., & Sampson, E. L. (2014). Risk factors for incident delirium among older people in acute hospital medical units: A systematic review and meta-analysis. Age and Ageing, 43(3), 326-333.
Alagiakrishnan, K., Marrie, T., Rolfson, D., Coke, W., Camicioli, R., Duggan, D. A., Launhardt, B., Fisher, B., Gordon, D., & Hervas‐Malo, M. (2007). Simple cognitive testing (Mini‐Cog) predicts in‐hospital delirium in the elderly. Journal of the American Geriatrics Society, 55(2), 314-316.
Angel, S., & Vatne, S. (2017). Vulnerability in patients and nurses and the mutual vulnerability in the patient–nurse relationship. Journal of Clinical Nursing, 26(9-10), 1428-1437.
Arora, R. C., Djaiani, G., & Rudolph, J. L. (2017). Detection, prevention, and management of delirium in the critically ill cardiac patient and patients who undergo cardiac procedures. Canadian Journal of Cardiology, 33(1), 80-87.
Austin, A. W., Patterson, S. M., & von Känel, R. (2011). Hemoconcentration and hemostasis during acute stress: interacting and independent effects. Annals of Behavioral Medicine, 42(2), 153-173.
Austin, A. W., Wissmann, T., & von Kanel, R. (2013). Stress and hemostasis: an update. In Seminars in thrombosis and hemostasis (Vol. 39, No. 08, pp. 902-912). Thieme Medical Publishers.
Bachmann, L., Michaelsen, R. A., & Vatne, S. (2016). Feeling “overloaded” and “shortcomings”: Milieu therapists’ experiences of vulnerability in caring for severely mentally ill patients. Journal of Multidisciplinary Healthcare, 9, 285.
Bagnato, S., Boccagni, C., Marino, G., Prestandrea, C., D’Agostino, T., & Rubino, F. (2020). Critical illness myopathy after COVID-19. International Journal of Infectious Diseases, 99, 276-278.
Balas, M. C., Burke, W. J., Gannon, D., Cohen, M. Z., Colburn, L., Bevil, C., Franz, D., Olsen, K. M., Ely, E. W., & Vasilevskis, E. E. (2013). Implementing the awakening and breathing coordination, delirium monitoring/management, and early exercise/mobility bundle into everyday care: opportunities, challenges, and lessons learned for implementing the ICU Pain, Agitation, and Delirium Guidelines. Critical Care Medicine, 41(9), S116-S127.
Beckett, M. K., Elliott, M. N., Ritenour, D., Giordano, L. A., Grace, S. C., Malinoff, R., & Saliba, D. (2017). Adapting the Vulnerable Elders Survey‐13 to Predict Mortality Using Responses to the Medicare Health Outcomes Survey. Journal of the American Geriatrics Society, 65(5), 1051-1055.
Bellelli, G., Moresco, R., Panina-Bordignon, P., Arosio, B., Gelfi, C., Morandi, A., & Cesari, M. (2017). Is delirium the cognitive harbinger of frailty in older adults? A review about the existing evidence. Frontiers in Medicine, 4, 188.
Benjamin Emelia, J., Muntner, P., Alonso, A., Bittencourt Marcio, S., Callaway Clifton, W., Carson April, P., Chamberlain Alanna, M., Chang Alexander, R., Cheng, S., Das Sandeep, R., Delling Francesca, N., Djousse, L., Elkind Mitchell, S. V., Ferguson Jane, F., Fornage, M., Jordan Lori, C., Khan Sadiya, S., Kissela Brett, M., Knutson Kristen, L., …, Null, N. (2019). Heart Disease and Stroke Statistics—2019 Update: A Report From the American Heart Association. Circulation, 139(10), e56-e528. https://doi.org/10.1161/CIR.0000000000000659
Benson, R., Ozdemir, B., Matthews, D., & Loftus, I. (2017). A systematic review of postoperative cognitive decline following open and endovascular aortic aneurysm surgery. The Annals of The Royal College of Surgeons of England, 99(2), 97-100.
Boettger, S., Garcia Nuñez, D., Meyer, R., Richter, A., Rudiger, A., Schubert, M., & Jenewein, J. (2018). Screening for delirium with the Intensive Care Delirium Screening Checklist (ICDSC): a re-evaluation of the threshold for delirium. Swiss medical weekly, 148(1112).
Bourgois, P., Holmes, S. M., Sue, K., & Quesada, J. (2017). Structural vulnerability: operationalizing the concept to address health disparities in clinical care. Academic medicine: journal of the Association of American Medical Colleges, 92(3), 299.
Bozza, F. A., D’Avila, J. C., Ritter, C., Sonneville, R., Sharshar, T., & Dal-Pizzol, F. (2013). Bioenergetics, mitochondrial dysfunction, and oxidative stress in the pathophysiology of septic encephalopathy. Shock, 39, 10-16.
Breen, T. J., Bennett, C. E., Van Diepen, S., Katz, J., Anavekar, N. S., Murphy, J. G., Bell, M. R., Barsness, G. W., & Jentzer, J. C. (2021). The Mayo Cardiac Intensive Care Unit Admission Risk Score is Associated with Medical Resource Utilization During Hospitalization. Mayo Clinic Proceedings: Innovations, Quality & Outcomes, 5(5), 839-850.
Brummel, N. E., Bell, S. P., Girard, T. D., Pandharipande, P. P., Jackson, J. C., Morandi, A., Thompson, J. L., Chandrasekhar, R., Bernard, G. R., & Dittus, R. S. (2017). Frailty and subsequent disability and mortality among patients with critical illness. American Journal of Respiratory and Critical Care Medicine, 196(1), 64-72.
Brummel, N. E., Jackson, J. C., Pandharipande, P. P., Thompson, J. L., Shintani, A. K., Dittus, R. S., Gill, T. M., Bernard, G. R., Ely, E. W., & Girard, T. D. (2014). Delirium in the intensive care unit and subsequent long-term disability among survivors of mechanical ventilation. Critical Care Medicine, 42(2), 369.
Campo, G., Pavasini, R., Pollina, A., Tebaldi, M., & Ferrari, R. (2013). Coagulation factors and recurrence of ischemic and bleeding adverse events in patients with acute coronary syndromes. Thrombosis Research, 132(2), 151-157.
Cavallazzi, R., Saad, M., & Marik, P. E. (2012). Delirium in the ICU: an overview. Annals of Intensive Care, 2(1), 1-11.
Cereghetti, C., Siegemund, M., Schaedelin, S., Fassl, J., Seeberger, M. D., Eckstein, F. S., Steiner, L. A., & Goettel, N. (2017). Independent predictors of the duration and overall burden of postoperative delirium after cardiac surgery in adults: an observational cohort study. Journal of Cardiothoracic and Vascular Anesthesia, 31(6), 1966-1973.
Chan, C. C. H., Fage, B. A., Burton, J. K., Smailagic, N., Gill, S. S., Herrmann, N., Nikolaou, V., Quinn, T. J., Noel‐Storr, A. H., & Seitz, D. P. (2019). Mini‐Cog for the diagnosis of Alzheimer’s disease dementia and other dementias within a secondary care setting. Cochrane Database of Systematic Reviews(9). https://doi.org/10.1002/14651858.CD011414.pub2
Chen, J., Yu, J., & Zhang, A. (2020). Delirium risk prediction models for intensive care unit patients: A systematic review. Intensive and Critical Care Nursing, 60, 102880.
Covinsky, K. E., Palmer, R. M., Fortinsky, R. H., Counsell, S. R., Stewart, A. L., Kresevic, D., Burant, C. J., & Landefeld, C. S. (2003). Loss of independence in activities of daily living in older adults hospitalized with medical illnesses: increased vulnerability with age. Journal of the American Geriatrics Society, 51(4), 451-458.
Crooks, V., Waller, S., Smith, T., & Hahn, T. J. (1991). The use of the Karnofsky Performance Scale in determining outcomes and risk in geriatric outpatients. Journal of Gerontology, 46(4), M139-M144.
Davis, D. H. J., Muniz-Terrera, G., Keage, H. A. D., Stephan, B. C. M., Fleming, J., Ince, P. G., Matthews, F. E., Cunningham, C., Ely, E. W., MacLullich, A. M. J., Brayne, C., & Members, f. t. E. C. S. i. E. C. (2017). Association of Delirium With Cognitive Decline in Late Life: A Neuropathologic Study of 3 Population-Based Cohort Studies. JAMA psychiatry, 74(3), 244-251.
https://doi.org/10.1001/jamapsychiatry.2016.3423
De Witte, N., De Donder, L., Dury, S., Buffel, T., Verte, D., & Schols, J. (2013). A theoretical perspective on the conceptualisation and usefulness of frailty and vulnerability measurements in community dwelling older adults. Aporia: The Nursing Journal, 5(1), 13-31.
Duffin, J., Hare, G. M., & Fisher, J. A. (2020). A mathematical model of cerebral blood flow control in anaemia and hypoxia. The Journal of Physiology, 598(4), 717-730.
Dworkin, A., Lee, D. S., An, A. R., & Goodlin, S. J. (2016). A simple tool to predict development of delirium after elective surgery. Journal of the American Geriatrics Society, 64(11), e149-e153.
El-Sharkawy, A., Virdee, A., Wahab, A., Humes, D., Sahota, O., Devonald, M., & Lobo, D. (2017). Dehydration and clinical outcome in hospitalised older adults: A cohort study. European Geriatric Medicine, 8(1), 22-29.
Ely, E. W., Shintani, A., Truman, B., Speroff, T., Gordon, S. M., Harrell Jr, F. E., Inouye, S. K., Bernard, G. R., & Dittus, R. S. (2004). Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. JAMA, 291(14), 1753-1762.
Eshmawey, M., Arlt, S., Ledschbor-Frahnert, C., Guenther, U., & Popp, J. (2019). Preoperative depression and plasma cortisol levels as predictors of delirium after cardiac surgery. Dementia and Geriatric Cognitive Disorders, 48(3-4), 207-214.
Etgen, T., Sander, D., Huntgeburth, U., Poppert, H., Förstl, H., & Bickel, H. (2010). Physical activity and incident cognitive impairment in elderly persons: the INVADE study. Archives of Internal Medicine, 170(2), 186-193.
Fatehi Hassanabad, A., Bahrami, N., Novick, R. J., & Ali, I. S. (2021). Delirium and depression in cardiac surgery: A comprehensive review of risk factors, pathophysiology, and management. Journal of Cardiac Surgery, 36(8), 2876-2889.
Falsini, G., Grotti, S., Porto, I., Toccafondi, G., Fraticelli, A., Angioli, P., Ducci, K., Liistro, F., Pieroni, M., & Taddei, T. (2018). Long-term prognostic value of delirium in elderly patients with acute cardiac diseases admitted to two cardiac intensive care units: a prospective study (DELIRIUM CORDIS). European Heart Journal: Acute Cardiovascular Care, 7(7), 661-670.
Fernandez, R., Bacelar, N., Hernandez, G., Tubau, I., Baigorri, F., Gili, G., & Artigas, A. (2008). Ward mortality in patients discharged from the ICU with tracheostomy may depend on patient’s vulnerability. Intensive Care Medicine, 34(10), 1878-1882.
Ferri, F. F. (2019). Ferri's Clinical Advisor 2020 E-Book: 5 Books in 1. Elsevier Health Sciences.
Fink, G. (2016). In retrospect: Eighty years of stress. Nature, 539(7628), 175.
Folstein, M. F., Folstein, S. E., & McHugh, P. R. (1975). “Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12(3), 189-198.
Fong, T. G., Inouye, S. K., & Jones, R. N. (2017). Delirium, dementia, and decline. JAMA psychiatry, 74(3), 212-213.
Fuster, V. (2018). The (R) Evolution of the CICU: better for the patient, better for education. Journal of the American College of Cardiology, 72(18), 2269-2271.
Galloway, M. P., & White, F. J. (1991). Cocaine: Pharamacology, Physiology, and Clinical Strategies. CRC Press.
Galyfos, G. C., Geropapas, G. E., Sianou, A., Sigala, F., & Filis, K. (2017). Risk factors for postoperative delirium in patients undergoing vascular surgery. Journal of Vascular Surgery, 66(3), 937-946.
García, A. M., Guerrero, O. P. J., Chaves, E. C., Aranda, L. G., Mayor, S. G., & Asencio, J. M. M. (2020). Psychometric design and validation of an adverse event vulnerability scale in prehospital emergency care. Journal of Patient Safety, 16(4), e267-e272.
George, C., Nair, J. S., Ebenezer, J. A., Gangadharan, A., ChristuDas, A., Gnanaseelan, L. K., & Jacob, K. (2011). Validation of the Intensive Care Delirium Screening Checklist in nonintubated intensive care unit patients in a resource-poor medical intensive care setting in South India. Journal of Critical Care, 26(2), 138-143.
Gjengedal, E., Ekra, E. M., Hol, H., Kjelsvik, M., Lykkeslet, E., Michaelsen, R., Orøy, A., Skrondal, T., Sundal, H., & Vatne, S. (2013). Vulnerability in health care–reflections on encounters in every day practice. Nursing Philosophy, 14(2), 127-138.
Gosselt, A. N., Slooter, A. J., Boere, P. R., & Zaal, I. J. (2015). Risk factors for delirium after on-pump cardiac surgery: a systematic review. Critical Care, 19(1), 346.
Gual, N., Inzitari, M., Carrizo, G., Calle, A., Udina, C., Yuste, A., & Morandi, A. (2018). Delirium subtypes and associated characteristics in older patients with exacerbation of chronic conditions. The American Journal of Geriatric Psychiatry, 26(12), 1204-1212.
Hardin, S. R. (2015). Vulnerability of older patients in critical care. Critical care nurse, 35(3), 55-61.
Hermanides, J., Qeva, E., Preckel, B., & Bilotta, F. (2018). Perioperative hyperglycemia and neurocognitive outcome after surgery: a systematic review. Minerva Anestesiologica, 84(10), 1178-1188.
Holsinger, T., Plassman, B. L., Stechuchak, K. M., Burke, J. R., Coffman, C. J., & Williams Jr, J. W. (2012). Screening for cognitive impairment: comparing the performance of four instruments in primary care. Journal of the American Geriatrics Society, 60(6), 1027-1036.
Honda, S., Nagai, T., Sugano, Y., Okada, A., Asaumi, Y., Aiba, T., Noguchi, T., Kusano, K., Ogawa, H., & Yasuda, S. (2016). Prevalence, determinants, and prognostic significance of delirium in patients with acute heart failure. International Journal of Cardiology, 222, 521-527.
Hope, A. A., Chen, J.-T., Kaufman, D. A., Talmor, D. S., Kor, D. J., Gajic, O., & Gong, M. N. (2019). The Association between Prehospital Vulnerability, ARDS Development, and Mortality among At-Risk Adults. Results from the LIPS-A Clinical Trial. Annals of the American Thoracic Society, 16(11), 1399-1404.
Hope, A. A., Hsieh, S., Hurtado-Sbordoni, M., Petti, A. M., & Gong, M. N. (2015). A104 MOVING THE NEEDLE ON ICU-ASSOCIATED NEUROMUSCULAR WEAKNESS: Frailty Assessment And Hospital Outcomes In Critically Ill Patients. American Journal of Respiratory and Critical Care Medicine, 191, 1.
Hosker, C., & Ward, D. (2017). Hypoactive delirium. BMJ, 357.
Hshieh, T. T., Yue, J., Oh, E., Puelle, M., Dowal, S., Travison, T., & Inouye, S. K. (2015). Effectiveness of multicomponent nonpharmacological delirium interventions: a meta-analysis. JAMA Internal Medicine, 175(4), 512-520.
Hu, J.-L., Chang, M.-C., & Chung, H.-J. (2020). Projecting the target quantity of medical staff in Taiwan’s administrative regions by the theory of carrying capacity. International Journal of Environmental Research and Public Health, 17(9), 2998.
Hughes, C. G., Hayhurst, C. J., Pandharipande, P. P., Shotwell, M. S., Feng, X., Wilson, J. E., Brummel, N. E., Girard, T. D., Jackson, J. C., & Ely, E. W. (2021). Association of Delirium during Critical Illness With Mortality: Multicenter Prospective Cohort Study. Anesthesia & Analgesia, 10.1213.
Hughes, C. G., Patel, M. B., Brummel, N. E., Thompson, J. L., McNeil, J. B., Pandharipande, P. P., Jackson, J. C., Chandrasekhar, R., Ware, L. B., & Ely, E. W. (2018). Relationships between markers of neurologic and endothelial injury during critical illness and long-term cognitive impairment and disability. Intensive Care Medicine, 44(3), 345-355.
Ingram, R. E., & Luxton, D. D. (2005). Vulnerability-stress models. Development of psychopathology: A vulnerability-stress perspective, 46.
Inouye, S. K., Westendorp, R. G., & Saczynski, J. S. (2014). Delirium in elderly people. The Lancet, 383(9920), 911-922.
Jentzer, J. C., Anavekar, N. S., Bennett, C., Murphree, D. H., Keegan, M. T., Wiley, B., Morrow, D. A., Murphy, J. G., Bell, M. R., & Barsness, G. W. (2019). Derivation and validation of a novel cardiac intensive care unit admission risk score for mortality. Journal of the American Heart Association, 8(17), e013675.
Johnson, M. J., Bland, J. M., Davidson, P. M., Newton, P. J., Oxberry, S. G., Abernethy, A. P., & Currow, D. C. (2014). The relationship between two performance scales: New York Heart Association classification and Karnofsky performance status scale. Journal of Pain and Symptom Management, 47(3), 652-658.
Jolley, S. E., Bunnell, A. E., & Hough, C. L. (2016). ICU-acquired weakness. Chest, 150(5), 1129-1140.
Joudi, M., Fathi, M., Harati, H., Joudi, M., Izanloo, A., Rahdari, A., & Soltani, G. (2014). Evaluating the incidence of cognitive disorder following off-pump coronary artery bypasses surgery and its predisposing factors. Anesthesiology and Pain Medicine, 4(4).
Jung, P., Pereira, M. A., Hiebert, B., Song, X., Rockwood, K., Tangri, N., & Arora, R. C. (2015). The impact of frailty on postoperative delirium in cardiac surgery patients. The Journal of Thoracic and Cardiovascular Surgery, 149(3), 869-875. e862.
Kalyoncuoğlu, M., Biter, H. İ., Durmuş, G., Baştan, B., & Can, M. M. (2020). C-reactive Protein to Albumin Ratio as A Novel Inflammatory Biomarker for Postoperative Delirium in Patients Undergoing Transcatheter Aortic Valve Replacement. Medical Bulletin of Haseki, 58(2).
Karnatovskaia, L. V., Philbrick, K. L., Parker, A. M., & Needham, D. M. (2016). Early psychological therapy in critical illness. Seminars in respiratory and critical care medicine (Vol. 37, No. 01, pp. 136-142). Thieme Medical Publishers.
Kasaoka, S. (2017). Evolved role of the cardiovascular intensive care unit (CICU). Journal of Intensive Care, 5(1), 72.
Keage, H. A., Smith, A., Loetscher, T., & Psaltis, P. (2016). Cognitive outcomes of cardiovascular surgical procedures in the old: an important but neglected area. Heart, Lung and Circulation, 25(12), 1148-1153. https://doi.org/https://doi.org/10.1016/j.hlc.2016.09.002
Kearns, M. C., Ressler, K. J., Zatzick, D., & Rothbaum, B. O. (2012). Early interventions for PTSD: a review. Depression and Anxiety, 29(10), 833-842.
Khan, A. H., Tirth, V., Fawzy, M., Mahmoud, A. E. D., Khan, N. A., Ahmed, S., Ali, S. S., Akram, M., Hameed, L., & Islam, S. (2021). COVID-19 transmission, vulnerability, persistence and nanotherapy: a review. Environmental Chemistry Letters, 19(4), 2773-2787.
Knaus, W. A., Draper, E. A., Wagner, D. P., & Zimmerman, J. E. (1985). APACHE II: a severity of disease classification system. Critical Care Medicine, 13(10), 818-829.
Koch, S., Spuler, S., Deja, M., Bierbrauer, J., Dimroth, A., Behse, F., Spies, C. D., Wernecke, K.-D., & Weber-Carstens, S. (2011). Critical illness myopathy is frequent: accompanying neuropathy protracts ICU discharge. Journal of Neurology, Neurosurgery & Psychiatry, 82(3), 287-293.
Koolhaas, J. M., Bartolomucci, A., Buwalda, B., de Boer, S. F., Flügge, G., Korte, S. M., Meerlo, P., Murison, R., Olivier, B., & Palanza, P. (2011). Stress revisited: a critical evaluation of the stress concept. Neuroscience & Biobehavioral Reviews, 35(5), 1291-1301.
Krewulak, K. D., Stelfox, H. T., Ely, E. W., & Fiest, K. M. (2020). Risk factors and outcomes among delirium subtypes in adult ICUs: A systematic review. Journal of Critical Care, 56, 257-264.
Kroenke, K., & Spitzer, R. L. (2002). The PHQ-9: a new depression diagnostic and severity measure. Psychiatric Annals, 32(9), 509-515.
Lambden, S., Laterre, P. F., Levy, M. M., & Francois, B. (2019). The SOFA score—development, utility and challenges of accurate assessment in clinical trials. Critical Care, 23(1), 1-9.
Ladha, K. S., Zhao, K., Quraishi, S. A., Kurth, T., Eikermann, M., Kaafarani, H. M., Klein, E. N., Seethala, R., & Lee, J. (2015). The Deyo-Charlson and Elixhauser-van Walraven Comorbidity Indices as predictors of mortality in critically ill patients. BMJ open, 5(9).
Le Maguet, P., & Gueret, G. (2020). What is the appropriate definition for vulnerability to identify silent pre-frail patients? Canadian Journal of Anesthesia/Journal Canadien d'anesthésie, 67(12), 1887-1888.
Liu, W., Jamshidian, M., & Zhang, Y. (2004). Multiple comparison of several linear regression models. Journal of the American Statistical Association, 99(466), 395-403.
Liu, S.-I., Yeh, Z.-T., Huang, H.-C., Sun, F.-J., Tjung, J.-J., Hwang, L.-C., Shih, Y.-H., & Yeh, A. W.-C. (2011). Validation of Patient Health Questionnaire for depression screening among primary care patients in Taiwan. Comprehensive Psychiatry, 52(1), 96-101.
Llewellyn, D. J., Langa, K. M., Friedland, R. P., & Lang, I. A. (2010). Serum Albumin Concentration and Cognitive Impairment. Current Alzheimer research, 7(1), 91.
Long, A. C., Kross, E. K., Davydow, D. S., & Curtis, J. R. (2014). Posttraumatic stress disorder among survivors of critical illness: creation of a conceptual model addressing identification, prevention, and management. Intensive Care Medicine, 40(6), 820-829.
Marengoni, A., Zucchelli, A., Grande, G., Fratiglioni, L., & Rizzuto, D. (2020). The impact of delirium on outcomes for older adults hospitalised with COVID-19. Age and Ageing, 49(6), 923-926.
Mattison, M. L. (2020). Delirium. Annals of Internal Medicine, 173(7), ITC49-ITC64.
McDermid, R. C., Stelfox, H. T., & Bagshaw, S. M. (2011). Frailty in the critically ill: a novel concept. Critical Care, 15(1), 1-6.
McKinley, S., Nagy, S., Stein-Parbury, J., Bramwell, M., & Hudson, J. (2002). Vulnerability and security in seriously ill patients in intensive care. Intensive and Critical Care Nursing, 18(1), 27-36.
McPherson, J. A., Wagner, C. E., Boehm, L. M., Hall, J. D., Johnson, D. C., Miller, L. R., Burns, K. M., Thompson, J. L., Shintani, A. K., & Ely, E. W. (2013). Delirium in the cardiovascular intensive care unit: exploring modifiable risk factors. Critical Care Medicine, 41(2), 405.
Min, L. C., Elliott, M. N., Wenger, N. S., & Saliba, D. (2006). Higher vulnerable elders survey scores predict death and functional decline in vulnerable older people. Journal of the American Geriatrics Society, 54(3), 507-511.
Mohile, S. G., Bylow, K., Dale, W., Dignam, J., Martin, K., Petrylak, D. P., Stadler, W. M., & Rodin, M. (2007). A pilot study of the vulnerable elders survey‐13 compared with the comprehensive geriatric assessment for identifying disability in older patients with prostate cancer who receive androgen ablation. Cancer: Interdisciplinary International Journal of the American Cancer Society, 109(4), 802-810.
Morrow, D. A., Fang, J. C., Fintel, D. J., Granger, C. B., Katz, J. N., Kushner, F. G., Kuvin, J. T., Lopez-Sendon, J., McAreavey, D., & Nallamothu, B. (2012). Evolution of critical care cardiology: transformation of the cardiovascular intensive care unit and the emerging need for new medical staffing and training models: a scientific statement from the American Heart Association. Circulation, 126(11), 1408-1428.
Moug, S., Stechman, M., McCarthy, K., Pearce, L., Myint, P., & Hewitt, J. (2016). Frailty and cognitive impairment: Unique challenges in the older emergency surgical patient. The Annals of The Royal College of Surgeons of England, 98(03), 165-169.
Mulkey, M. A., Hardin, S. R., Olson, D. M., & Munro, C. L. (2018). Pathophysiology review: seven neurotransmitters associated with delirium. Clinical Nurse Specialist, 32(4), 195-211.
Mutch, W. A. C., El-Gabalawy, R., Girling, L., Kilborn, K., & Jacobsohn, E. (2018). End-tidal hypocapnia under anesthesia predicts postoperative delirium. Frontiers in Neurology, 9, 678.
Neufeld, K. J., & Thomas, C. (2013). Delirium: definition, epidemiology, and diagnosis. Journal of Clinical Neurophysiology, 30(5), 438-442.
Nguyen, Q., Uminski, K., Hiebert, B. M., Tangri, N., & Arora, R. C. (2018). Midterm outcomes after postoperative delirium on cognition and mood in patients after cardiac surgery. The Journal of Thoracic and Cardiovascular Surgery, 155(2), 660-667. e662.
Nishimura, K., Yokoyama, K., Yamauchi, N., Koizumi, M., Harasawa, N., Yasuda, T., Mimura, C., Igita, H., Suzuki, E., & Uchiide, Y. (2016). Sensitivity and specificity of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) and the Intensive Care Delirium Screening Checklist (ICDSC) for detecting post-cardiac surgery delirium: A single-center study in Japan. Heart & Lung, 45(1), 15-20.
O'Sullivan, R., Inouye, S. K., & Meagher, D. (2014). Delirium and depression: inter-relationship and clinical overlap in elderly people. The Lancet Psychiatry, 1(4), 303-311.
Ofori-Asenso, R., Chin, K. L., Sahle, B. W., Mazidi, M., Zullo, A. R., & Liew, D. (2020). Frailty Confers High Mortality Risk across Different Populations: Evidence from an Overview of Systematic Reviews and Meta-Analyses. Geriatrics, 5(1), 17.
Ogawa, M., Izawa, K. P., Satomi-Kobayashi, S., Tsuboi, Y., Komaki, K., Gotake, Y., Sakai, Y., Tanaka, H., & Okita, Y. (2017). Impact of delirium on postoperative frailty and long term cardiovascular events after cardiac surgery. PLoS One, 12(12), e0190359.
Oldham, M. A., Hawkins, K. A., Lin, I.-H., Deng, Y., Hao, Q., Scoutt, L. M., Yuh, D. D., & Lee, H. B. (2019). Depression predicts delirium after coronary artery bypass graft surgery independent of cognitive impairment and cerebrovascular disease: an analysis of the neuropsychiatric outcomes after heart surgery study. The American Journal of Geriatric Psychiatry, 27(5), 476-486.
Oldham, M. A., Hawkins, K. A., Yuh, D. D., Dewar, M. L., Darr, U. M., Lysyy, T., & Lee, H. B. (2015). Cognitive and functional status predictors of delirium and delirium severity after coronary artery bypass graft surgery: an interim analysis of the Neuropsychiatric Outcomes After Heart Surgery study. International Psychogeriatrics, 27(12), 1929.
Patel, A., Parikh, R., Howell, E. H., Hsich, E., Landers, S. H., & Gorodeski, E. Z. (2015). Mini-cog performance: novel marker of post discharge risk among patients hospitalized for heart failure. Circulation: Heart Failure, 8(1), 8-16.
Pinzon, R. T., Wijaya, V. O., Buana, R. B., Al Jody, A., & Nunsio, P. N. (2020). Neurologic characteristics in coronavirus disease 2019 (COVID-19): a systematic review and meta-analysis. Frontiers in Neurology, 11, 565.
Post, R. M., Weiss, S. R., & Pert, A. (1991). Sensitization and Kindling Effects of chronic cocaine administration. Cocaine: Pharamacology, Physiology, and Clinical Strategies, 115-161.
Quinlan, N., Marcantonio, E. R., Inouye, S. K., Gill, T. M., Kamholz, B., & Rudolph, J. L. (2011). Vulnerability: the crossroads of frailty and delirium. Journal of the American Geriatrics Society, 59, S262-S268.
Rawal, G., Yadav, S., & Kumar, R. (2017). Post-intensive care syndrome: an overview. Journal of Translational Internal Medicine, 5(2), 90.
Reade, M. C., & Finfer, S. (2014). Sedation and delirium in the intensive care unit. New England Journal of Medicine, 370(5), 444-454.
Richardson, S. J., Davis, D. H., Stephan, B., Robinson, L., Brayne, C., Barnes, L., Parker, S., & Allan, L. M. (2017). Protocol for the Delirium and Cognitive Impact in Dementia (DECIDE) study: A nested prospective longitudinal cohort study. BMC geriatrics, 17(1), 98.
Rudolph, J. L., Jones, R. N., Levkoff, S. E., Rockett, C., Inouye, S. K., Sellke, F. W., Khuri, S. F., Lipsitz, L. A., Ramlawi, B., & Levitsky, S. (2009). Derivation and validation of a preoperative prediction rule for delirium after cardiac surgery. Circulation, 119(2), 229.
Sakusic, A., O'Horo, J. C., Dziadzko, M., Volha, D., Ali, R., Singh, T. D., Kashyap, R., Farrell, A. M., Fryer, J. D., & Petersen, R. (2018). Potentially modifiable risk factors for long-term cognitive impairment after critical illness: a systematic review. Mayo Clinic Proceedings, (Vol. 93, No. 1, pp. 68-82). Elsevier.
Saliba, D., Elliott, M., Rubenstein, L. Z., Solomon, D. H., Young, R. T., Kamberg, C. J., Carol Roth, R., MacLean, C. H., Shekelle, P. G., & Sloss, E. M. (2001). The Vulnerable Elders Survey: a tool for identifying vulnerable older people in the community. Journal of the American Geriatrics Society, 49(12), 1691-1699.
Scanlan, J., & Borson, S. (2001). The Mini‐Cog: receiver operating characteristics with expert and naïve raters. International Journal of Geriatric Psychiatry, 16(2), 216-222.
Schmidt, D., Piva, T. C., Glaeser, S. S., Piekala, D. M., Berto, P. P., Friedman, G., & Sbruzzi, G. (2022). Intensive Care Unit–Acquired Weakness in Patients With COVID-19: Occurrence and Associated Factors. Physical Therapy, 102(5), pzac028.
Selye, H. (2013). Stress in health and disease. Butterworth-Heinemann.
Sfera, A., Cummings, M., & Osorio, C. (2016). Dehydration and cognition in geriatrics: a hydromolecular hypothesis. Frontiers in Molecular Biosciences, 3, 18.
Shim, J., DePalma, G., Sands, L. P., & Leung, J. M. (2015). Prognostic significance of postoperative subsyndromal delirium. Psychosomatics, 56(6), 644-651.
Sillner, A. Y., McConeghy, R. O., Madrigal, C., Culley, D. J., Arora, R. C., & Rudolph, J. L. (2020). The Association of a Frailty Index and Incident Delirium in Older Hospitalized Patients: An Observational Cohort Study. Clinical interventions in Aging, 15, 2053.
Silveira, L. T. Y. d., Silva, J. M. d., Soler, J. M. P., Sun, C. Y. L., Tanaka, C., & Fu, C. (2018). Assessing functional status after intensive care unit stay: the Barthel Index and the Katz Index. International Journal for Quality in Health Care, 30(4), 265-270.
Simes, J., Robledo, K. P., White, H. D., Espinoza, D., Stewart, R. A., Sullivan, D. R., Zeller, T., Hague, W., Nestel, P. J., & Glasziou, P. P. (2018). D-dimer predicts long-term cause-specific mortality, cardiovascular events, and cancer in patients with stable coronary heart disease: LIPID study. Circulation, 138(7), 712-723.
Son, Y. J., Song, H. S., & Seo, E. J. (2020). Gender Differences Regarding the Impact of Change in Cognitive Function on the Functional Status of Intensive Care Unit Survivors: A Prospective Cohort Study. Journal of Nursing Scholarship, 52(4), 406-415.
Tabachnick, B. G., Fidell, L. S., & Ullman, J. B. (2007). Using multivariate statistics (Vol. 5). Pearson Boston, MA.
Tiwary, N., Treggiari, M. M., Yanez, N. D., Kirsch, J. R., Tekkali, P., Taylor, C. C., & Schenning, K. J. (2021). Agreement between the mini-cog in the preoperative clinic and on the day of surgery and association with postanesthesia care unit delirium: a cohort study of cognitive screening in older adults. Anesthesia & Analgesia, 132(4), 1112-1119.
Toft, K., Tontsch, J., Abdelhamid, S., Steiner, L., Siegemund, M., & Hollinger, A. (2019). Serum biomarkers of delirium in the elderly: a narrative review. Annals of Intensive Care, 9(1), 76.
Trogrlić, Z., van der Jagt, M., Bakker, J., Balas, M. C., Ely, E. W., van der Voort, P. H., & Ista, E. (2015, April 09). A systematic review of implementation strategies for assessment, prevention, and management of ICU delirium and their effect on clinical outcomes [journal article]. Critical Care, 19(1), 157. https://doi.org/10.1186/s13054-015-0886-9
Uguz, F., Kayrak, M., Çíçek, E., Kayhan, F., Ari, H., & Altunbas, G. (2010). Delirium following acute myocardial infarction: incidence, clinical profiles, and predictors. Perspectives in Psychiatric Care, 46(2), 135-142.
van der Wulp, K., van Wely, M. H., Rooijakkers, M. J., Brouwer, M. A., van den Boogaard, M., Pickkers, P., Rikkert, M. G. O., Delewi, R., Van Mieghem, N. M., & Baan, J. (2020). Delirium After TAVR: Crosspassing the Limit of Resilience. JACC: Cardiovascular Interventions, 13(21), 2453-2466.
Vasilevskis, E. E., Ely, E. W., Speroff, T., Pun, B. T., Boehm, L., & Dittus, R. S. (2010). Reducing iatrogenic risks: ICU-acquired delirium and weakness—crossing the quality chasm. Chest, 138(5), 1224-1233.
Vasunilashorn, S. M., Dillon, S. T., Inouye, S. K., Ngo, L. H., Fong, T. G., Jones, R. N., Travison, T. G., Schmitt, E. M., Alsop, D. C., & Freedman, S. D. (2017). High C‐reactive protein predicts delirium incidence, duration, and feature severity after major noncardiac surgery. Journal of the American Geriatrics Society, 65(8), e109-e116.
Wang, H. T., Carrier, F. M., Tremblay, A., Joly, M.-M., Ghali, R., Heckman, G., Hirdes, J. P., & Hebert, P. (2020). Outcomes of vulnerable elderly patients undergoing elective major surgery: a prospective cohort study. Canadian Journal of Anaesthesia= Journal Canadien D'anesthesie, 67(7), 847-856.
Wang, S., Allen, D., Kheir, Y. N., Campbell, N., & Khan, B. (2018). Aging and post–intensive care syndrome: a critical need for geriatric psychiatry. The American Journal of Geriatric Psychiatry, 26(2), 212-221.
Wang, S., Mosher, C., Perkins, A. J., Gao, S., Lasiter, S., Khan, S., Boustani, M., & Khan, B. (2017). Post-intensive care unit psychiatric comorbidity and quality of life. Journal of Hospital Medicine, 12(10), 831.
Whitlock, E. L., Vannucci, A., & Avidan, M. S. (2011). Postoperative delirium. Minerva Anestesiologica, 77(4), 448.
Wilcox, M. E., Brummel, N. E., Archer, K., Ely, E. W., Jackson, J. C., & Hopkins, R. O. (2013). Cognitive dysfunction in ICU patients: risk factors, predictors, and rehabilitation interventions. Critical Care Medicine, 41(9), S81-S98.
Wilson, M. G., & Morley, J. (2003). Impaired cognitive function and mental performance in mild dehydration. European Journal of Clinical Nutrition, 57(2), S24-S29.
Yin, H., Cheng, X., Liang, Y., Liu, A., Wang, H., Liu, F., Guo, L., Ma, H., & Geng, Q. (2021). High Perceived Stress May Shorten Activated Partial Thromboplastin Time and Lead to Worse Clinical Outcomes in Patients With Coronary Heart Disease. Frontiers in Cardiovascular Medicine, 8.
Zaal, I. J., Devlin, J. W., Peelen, L. M., & Slooter, A. J. (2015). A systematic review of risk factors for delirium in the ICU. Critical Care Medicine, 43(1), 40-47.
Zazzara, M. B., Penfold, R. S., Roberts, A. L., Lee, K. A., Dooley, H., Sudre, C. H., Welch, C., Bowyer, R. C., Visconti, A., & Mangino, M. (2021). Probable delirium is a presenting symptom of COVID-19 in frail, older adults: a cohort study of 322 hospitalised and 535 community-based older adults. Age and Ageing, 50(1), 40-48.
Zhang, D.-F., Su, X., Meng, Z.-T., Cui, F., Li, H.-L., Wang, D.-X., & Li, X.-Y. (2018). Preoperative severe hypoalbuminemia is associated with an increased risk of postoperative delirium in elderly patients: results of a secondary analysis. Journal of Critical Care, 44, 45-50.
Zuckerman, M., & Riskind, J. H. Vulnerability to Psychopathology: A Biosocial Model. J Cogn Psychother(4), 407-408. https://doi.org/10.1891/0889-8391.14.4.407
王淑惠（2009）‧成人加護病房疾病嚴重度分數系統‧重症醫學雜誌，10(3)，176-189。
朱育增、吳肖琪（2010）‧回顧與探討次級資料適用之共病測量方法‧台灣公共衛生雜誌，29(1)，8-21。https://doi.org/10.6288/tjph2010-29-01-02
莊玟玲、林健禾、許雯琪、丁郁茹、林高章、馬淑清（2007）‧加護病房混亂評估量表中文版信效度測試‧護理雜誌，54(4)，45-52。https://doi.org/10.6224/jn.54.4.45
郭蓓蓓、鄭守夏（2020）‧健保放寬降血脂藥物給付範圍對心血管疾病發生率及費用之影響‧台灣公共衛生雜誌，39(3)，269-277。https://doi.org/10.6288/tjph.202006_39(3).108132
陳玉樺（2018）‧回首向前，轉念成春：反芻思考、未來時間觀與寬恕之關係。〔未出版之博士論文〕‧國立政治大學教育學系。https://hdl.handle.net/11296/rpqtgr
陳秀蓉、康宜靜、張明裕、楊惠娟、謝孟蓁（2012）‧癲癇學童父母親壓力知覺與社會支持相關性探討‧台灣醫學，16(4)，350-358。https://doi.org/10.6320/fjm.2012.16(4).02
陳彰惠、曾英芬、王興耀、李昭男（1994）‧産後憂鬱的盛行率和預測因子‧護理研究，2(3)，263-274。https://doi.org/10.7081/nr.199409.0263
陳慶餘（2018）‧2020健康國民白皮書：老年衰弱及失能防治策略之進展‧台灣醫學，22(3)，253-260。https://doi.org/10.6320/fjm.201805_22(3).0004
葉玲瓏、李天行、陳銘芷、尤姵文（2016）‧運用健保資料庫進行冠狀動脈繞道手術相關研究之文獻回顧‧Journal of Data Analysis, 11(5), 13-26. https://doi.org/10.6338/jda.201610_11(5).0002
廖以誠、葉宗烈、楊延光、盧豐華、張智仁、柯慧貞、駱重鳴（2004）‧台灣老年憂鬱量表之編製與信、效度研究‧台灣精神醫學，18，30-41。
劉惠青、劉珣瑛、黃郁心、鍾嫈嫈、方俊凱（2011）‧北台灣高中職學生自傷盛行率及其危險因子之研究‧台灣家庭醫學雜誌，21(1)，27-39。https://doi.org/10.7023/tjfm.201103.0027
鄭玉昀（2020）‧心臟衰竭病人需求評估、心理健康與生活品質‧國立臺灣大學。