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研究生:陳冠仲
研究生(外文):CHEN, GUAN-JONG
論文名稱:探討拒絕鼻胃管的病患選擇經皮内視鏡胃造廔(PEG)手術之效益與相關影響因素—以南部某醫學中心為例
論文名稱(外文):Exploring the Benefit and Related Factors of Patient Decision in Choosing Percutaneous Endoscopic Gastrostomy (PEG) over Nasogastric Tube: A Single Center Study from the Southern Taiwan Medical System
指導教授:李易蓁李易蓁引用關係
指導教授(外文):LEE, I-CHEN
口試委員:姚卿騰劉秀月田奇玉
口試委員(外文):YAO, CHING-TENGLIU, HSIU-YUEHTIEN, CHI-YU
口試日期:2023-05-11
學位類別:碩士
校院名稱:高雄醫學大學
系所名稱:醫務管理暨醫療資訊學系碩士班
學門:商業及管理學門
學類:醫管學類
論文種類:學術論文
論文出版年:2023
畢業學年度:111
語文別:中文
論文頁數:81
中文關鍵詞:經皮内視鏡胃造廔鼻胃管吞嚥障礙台灣
外文關鍵詞:percutaneous endoscopic gastrostomynasogastric tubedysphagiaTaiwanPEG
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研究背景和目的:相較於歐美,台灣 PEG 手術實施和接受度遠低於全世界,在美國和加拿大,近 10%的住院老年患者通過 PEG 管接受腸內營養補充,但是台灣僅爲 2.8%,根據歐美文獻,PEG 手術為有吞嚥障礙的長輩所帶來的安全性和效益遠超於鼻胃管,PEG 管可提高患者的舒適度、改善營養狀況並改善患者的外觀,有較低手術相關死亡和減低相關併發症,如吸入性肺炎,本研究主要想探討台灣患者拒絕鼻胃管選擇經皮内視鏡胃造廔 (PEG) 手術之效益與相關影響因素。

研究方法:以高雄醫學大學附設中和紀念醫院的住院病患為母群體,向醫學統計分析及生物資訊研究室提出申請高醫體系醫院研究資料庫資料檔案進行回溯性分析,樣本收集 2015 年 1 月至 2020 年 9 月因吞嚥障礙於高雄醫學大學附設中和紀念醫院接受經皮內視鏡胃造廔術 (PEG) 的患者,並收集同時間住院而且接受鼻胃管灌食的患者作爲對照組,總共 841 筆資料,在相關影響因素方面,對患者性別、年齡、更換鼻胃管次數、住院天數和患者的決擇進行分析,在所產生的效益,
對患者死亡、患者死因腫瘤、患者死因心腦血管疾病、患者死因肺炎進行分析,使用 SPSS 20 完成單變項獨立樣本 t 檢定、卡方檢定、邏吉斯迴歸分析以及多變項邏吉斯迴歸分析。

結果:住院天數和更換鼻胃管次數對患者拒絕鼻胃管選擇 PEG 手術有顯著影響,住院天數對選擇 PEG 手術是有顯著關係(p < 0.05),住院天數每增加一個單位,其患者選擇接受 PEG 手術為原先選擇鼻胃管的 1.02 倍,更換鼻胃管次數越高,其拒絕鼻胃管選擇 PEG 手術的幾率會越低(p < 0.05),更換鼻胃管次數每增加一個單位,拒絕鼻胃管選擇 PEG 手術的幾率會降低為原先的 0.57 倍,同時,拒絕鼻胃管選擇 PEG 手術對患者死因腫瘤是有顯著關係(p < 0.05),選擇 PEG 手術次數每增加一個單位,其患者死因是腫瘤的幾率為原先選擇鼻胃管的2.62 倍。

討論:住院天數和更換鼻胃管次數對台灣患者拒絕鼻胃管選擇 PEG 手術有顯著影響,但是有別於歐美研究和臨床經驗,PEG 相較於鼻胃管和患者死因腫瘤有很高的關聯,同時並沒有減低肺炎死因的相關性。
Objective: In comparison with that of Europe and the United States, the implementation and acceptance of PEG surgery in Taiwan is far lower than the rest of the world. In the western countries, nearly 10% of hospitalized elderly patients receive enteral nutrition supplementation through PEG tubes, but only 2.8% in Taiwan. According to European and American literatures, The safety and benefits of PEG surgery for elders with dysphagia far exceed those of nasogastric tubes. PEG tubes can improve patient comfort, nutritional status, patient appearance, lower surgery-related mortality, and reduce related complications, such as aspiration pneumonia. This study aims to explore the benefits and related influencing factors of Taiwanese patients’ decision in refusing nasogastric tube and opting for percutaneous endoscopic gastrostomy (PEG).

Materials and Methods: The study subjects came from the inpatients of Kaohsiung Medical University Chung-Ho Memorial Hospital. A retrospective study was conducted. Data were collected from January 2015 to September 2020. The study subjects were patients who received percutaneous endoscopic gastrostomy (PEG) due to dysphagia. The control subjects were patients who were hospitalized at the same time and received nasogastric tube. 841 patient data were collected. The factors that were analyzed include patient's gender, age, number of nasogastric tube replacements, and length of stay in hospital. Additionally, associated benefits of choosing PEG were analyzed through its relation with patient mortality, cause of death related to cancer, cause of death related to cardiovascular and cerebral vascular disease, and cause of death related to pneumonia. Statistical analysis were conducted using SPSS 20. Univariate independent t test, chi-square analysis, logistic regression, and multivariate logistic regression analysis were conducted.

Results: The number of hospitalization days and the number of nasogastric tube replacements had a significant impact on patients' refusal of nasogastric tube and choosing PEG surgery. Length of hospital stay had a significant relationship with the choice of PEG surgery (p < 0.05). Every additional day of hospital stay leads to a patient 1.02 times more likely to choose PEG surgery. The number of nasogastric tube replacements is also significantly related to patient’s choice of rejecting PEG surgery for nasogastric tube (p < 0.05). For each additional unit of nasogastric tube replacement, the probability of choosing PEG surgery will be reduced by 0.57 times. At the same time, when patients choose PEG surgery, it has a significant relationship with the cause of death of the patients being attributed to cancer (p < 0.05). Patients who choose PEG surgery is 2.62 times more likely to die of cancer than that of the patients who choose nasogastric tube.

Discussion: The length of hospital stay and the number of nasogastric tube replacements have a significant impact on Taiwanese patients’ refusal to choose nasogastric tube and opt for PEG surgery. However, different from European and American research and clinical findings, PEG compared to nasogastric tube is actually strongly associated with tumor-related cause of death. Also, choosing PEG did not reduce its correlation with pneumonia as patient’s cause of death.
中文摘要 1

ABSTRACT 3

致謝 6

目錄 7

圖目錄 10

表目錄 11

第一章 緒論 12
第一節 研究背景和動機 12
第二節 研究目的 15

第二章 文獻探討 17
第一節 經皮内視鏡胃造廔 (PEG) 手術概論 17
第二節 PEG 手術相較鼻胃管的健康效益 22
第三節 台灣 PEG 手術實施數低於歐美醫療體系現象探討 26

第三章 研究方法 32
第一節 研究設計 32
第二節 資料來源 34
第三節 研究樣本篩檢流程圖 36
第四節 名詞定義 37
第五節 倫理考量 39
第六節 資料處理和統計分析 40

第四章 研究結果 41
第一節 樣本基本資料之描述 41
第二節 經皮內視鏡胃造廔術 (PEG) 患者之差異檢定 43
第三節 經皮內視鏡胃造廔術 (PEG) 相關影響因素之迴歸分析 46
第四節 經皮內視鏡胃造廔術 (PEG) 效益之迴歸分析 48

第五章 討論與建議 53
第一節 研究假說驗證與討論 53
第二節 研究限制與未來研究方向 61
第三節 結論與建議 62

第六章 參考文獻 67
英文文獻 67
中文文獻 77

第七章 附錄 79
附件一 人體研究新案同意證明書 79
附件二 人體研究變更案同意證明書 80
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中文文獻

王芊淩(2019 年 12 月 16 日)。台灣使用鼻胃管高出日本 5 倍! 復
健助拔管移除率高 23% 。Heho 健康電子報文章。
https://heho.com.tw/archives/61656.

尹祚芊(2006)。鼻胃管灌食法。臨床護理技術與處置規範,146-148
。台北:時新。

江文忍、林晏如、張家慧、陳筱瑀(2012)。經皮內視鏡胃造口之介
紹及其護理。護理雜誌 ,59 卷 4 期 , 94 - 98。DOI:
10.6224/JN.59.4.9

李宜芸(2016 年 4 月 1 日)。拿掉鼻胃管 再老也要好好吃 (高醫大
口腔衛生學系教授黃純德受訪) 。康健雜誌 210 期。
https://www.commonhealth.com.tw/article/71321.

林素香(2010)。居家護理常見技術與管路照護。於何瓊芬總校閱,
居家護理,二版,147-203。新北市:新文京。

范光中、許永河(2010)。台灣人口高齡化的社經衝擊。台灣老年醫
學暨老年學雜誌 , 5 卷 3 期,149 - 168。DOI:
10.29461/TGG.201008.0001

陳時中(2018)。國立陽明大學牙醫學院、衛生福利部(編)。107
年度「咀嚼吞嚥障礙評估訓練及宣導計畫」手冊,2。

陳桂敏(2014)。台灣長期照護發展的困境與出路。 高醫醫訊,
v33,n11,pp 8。

國家發展委員會人口推估查詢系統(2020)。國家發展委員會「中華
民國人口推 估(2020 至 2070 年)」。https://popproj.ndc.gov.tw/chart.aspx?c=10&uid=66&pid=60

黃美溶、林捷忠、鄭淑玲 (2004) 。實施經皮内視鏡胃造瘻術病童之
照護 。護理雜誌 ,51 (3) ,76-80。

葉莉莉(2008)。經皮內視鏡胃造口-長期營養支持的較佳選擇。長 期照護雜誌,12(1),116-125。

鄭郁蓁(2018 年 8 月 11 日)。台長照 94%插鼻胃管全球最高。中國時
報。https://www.chinatimes.com/newspapers/20180811000520-260114?
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蔡騌圳、許秉毅(2013)。鼻胃管灌食外的新選擇-經皮內視鏡胃造 口術。高雄醫師會雜誌,VOL. 21,
No. 4。http://www.doctor.org.tw/file/81-3-2.pdf

衛生福利部統計處 (2022)。110 年國人死因統計結果。
https://www.mohw.gov.tw/cp-16-70314-1.html

鍾俊文(2004)。少子化、人口老化及人口減少的成因、衝擊與對策。
台灣經濟論衡 , 2 卷 6 期,11 - 46。

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