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研究生:王俐芯
研究生(外文):Wang, Li-Hsin
論文名稱:接受急性後期住院照護之中高齡中風病人移除鼻胃管的相關因子
論文名稱(外文):Factors Associated with Nasogastric Tube Removal among Middle-aged and Older Patients with Stroke in Post-Acute Care
指導教授:范聖育范聖育引用關係
指導教授(外文):Fan, Sheng-Yu
口試委員:楊宜青楊登棋
口試委員(外文):Yang, Yi-ChingYang, Deng-Chi
口試日期:2023-07-26
學位類別:碩士
校院名稱:國立成功大學
系所名稱:老年學研究所
學門:其他學門
學類:其他不能歸類之各學類
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:46
中文關鍵詞:吞嚥障礙中高齡高齡鼻胃管急性後期照護中風
外文關鍵詞:DysphagiaMiddle-aged patientsNasogastric tubePost-Acute CareStroke
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台灣在2021年使用鼻胃管管灌的人數有19.6萬人,且每五位高齡住院病人就有一人是使用鼻胃攝取每日所需營養。但使用鼻胃管無法降低吸入性肺炎的發生,長期使用還可能造成鼻腔及食道潰傷、胃食道逆流、再入院機率增加、生活品質下降等負向影響。鼻胃管移除或縮短使用天數有助於鼻胃管灌食病人的照護品質。
本研究探討接受急性後期照護(Post-acute care, PAC)之中高齡中風病人接受照護後至第三週吞嚥及身心理功能的改變量與鼻胃管移除、以及鼻胃管使用天數之相關。研究設計採縱貫式回溯性研究,於南部某區域教學醫院進行收案。研究參與者為45歲以上入住急性後期整合照護病房、且使用鼻胃管管灌病人。評估時間點為入院初評、入院後第三週以及出院結案,收集人口學變項、疾病診斷、失能嚴重程度、日常生活功能、吞嚥功能、認知功能、上肢動作功能、感覺功能、營養狀況、溝通語言能力;以及出院時是否有移除鼻胃管、與鼻胃管使用天數。使用邏輯斯迴歸探索哪些功能的改變量可以預測鼻胃管移除;使用多元迴歸預測鼻胃管使用天數,找出哪些特性的病人可以較早移除鼻胃管。
本研究共納入66位接受PAC照護的中高齡中風病人,平均年齡68.97歲(SD = 11.58),75.76%為男性。結束PAC照護前有57位病人移除鼻胃管,鼻胃管移除率為86.36%,鼻胃管平均使用天數為17.79天(SD = 9.76)。吞嚥功能的改變量(B = 1.22, p = .017)與鼻胃管移除有顯著相關。日常生活功能(B = -0.13, p = .031)與營養狀態(B = -0.93, p = .031),功能改變量和鼻胃管使用天數有顯著負相關。功能性由口進食障礙量表評估之吞嚥功能每提升一級,移除機率多了1.22倍。日常生活功能與營養狀態提升越多,則會有較短的鼻胃管使用天數。
本研究顯示吞嚥功能、日常生活功能及營養狀態的改變量,與鼻胃管移除或使用天數有關。針對弱項因子加強介入訓練並補充所需的營養攝取,能提升中高齡中風族群的鼻胃管移除成效和縮短鼻胃管的使用時間。
The use of NG tubes cannot prevent aspiration pneumonia, and prolonged use of NG tubes may lead to complications. Removing or shortening the duration of NG tube can improve the quality of care. Therefore, the aims of this study were to investigate factors related to the removal of NG tube among middle-aged and older patients in post-acute care (PAC). The research design employed a longitudinal retrospective study conducted in a regional teaching hospital in Southern Taiwan. Data collection included demographic variables, disease diagnosis, disability severity, activities of daily living, swallowing function, cognitive function, upper limb motor function, sensory function, nutritional status, and communication ability at admission, at the third week, and at discharge. Logistic regression was used to explore the significant factors associated with the removal of NG tube, and multivariate regression for the duration of NG tubes use. A total of 66 patients were recruited, and 57 patients had the NG tubes removed before discharge (86.36%). The average duration of NG tube use was 17.79 days (SD = 9.76). The improvement of swallowing function (B = 1.22, p = 0.017) significantly related to the removal of NG tube. The changes in activity of daily living (B = -0.13, p = .031) and nutritional status (B = -0.93, p = .031) negatively correlated with the duration of NG tube use. The improvements in swallowing function, ADL, and nutritional status were associated with NG tubes removal or the duration.
摘要 I
誌謝 VII
目錄 VIII
表目錄 X
圖目錄 XI
第一章 緒論 1
第一節 研究背景及動機 1
第二節 研究問題與假設 2
第二章 文獻探討 4
第一節 臺灣鼻胃管的使用現況 4
第二節 鼻胃管的負向影響以及政府改善政策 4
第三節 鼻胃管移除的相關因子 5
第四節 全民健康保險急性後期整合照護計畫(PAC) 8
第五節 研究缺口 9
第三章 研究方法 10
第一節 研究參與者 10
第二節 研究設計 11
第五節 資料收集 12
第六節 統計分析 15
第四章 研究結果 16
第一節 收案流程 16
第二節 鼻胃管移除之相關因子 17
第三節 鼻胃管使用天數之相關因子 22
第五章 討論 26
第一節 鼻胃管移除之相關因子 26
第二節 鼻胃管使用天數之相關因子 28
第三節 臨床應用與研究限制 30
參考文獻 32
附錄一 人體試驗計畫同意書 36
附錄二 研究使用評估工具 37
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