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研究生:劉玉嬌
研究生(外文):LIU,YU-CHIAO
論文名稱:應用WEANSNOW評估於呼吸器依賴病人脫離呼吸器之成效探討
論文名稱(外文):Study on the Effectiveness of Applying WEANSNOW to Evaluate the Weaning of Respirator-Dependent Patients from Mechanical Ventilators
指導教授:李秋香李秋香引用關係白香菊白香菊引用關係
指導教授(外文):LEE,CHIU-HSIANGPAI,HSIANG-CHU
口試委員:李秋香白香菊陳玉如
口試委員(外文):LEE,CHIU-HSIANGPAI,HSIANG-CHUChen,Yu-Ju
口試日期:2024-01-17
學位類別:碩士
校院名稱:中山醫學大學
系所名稱:護理學系長期照護碩士在職專班
學門:醫藥衛生學門
學類:護理學類
論文種類:學術論文
論文出版年:2024
畢業學年度:112
語文別:中文
論文頁數:85
中文關鍵詞:呼吸衰竭呼吸器脫離WEANSNOW評估
外文關鍵詞:Respiratory failureVentilator weaningWEANSNOW assessment
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研究背景:當患者長期依賴呼吸器時,隨著病程進展及時間的推移,呼吸器相關併發症發生機率逐漸提高,進而增加了脫離呼吸器的困難度,因此積極呼吸器訓練脫離是相當重要的。
研究目的:探討應用「WEANSNOW」評估介入於呼吸器脫離過程是否有助提高呼吸器脫離率、改善病患呼吸困難程度,並探討「WEANSNOW」評估中有無成功脫離呼吸器之相關因素,期望研究結果能為臨床實務提供參考。
研究方法:本研究採類實驗研究設計(Quasi-experimental design),以使用呼吸器患者為研究對象。收案期間是2022年4月1日至2023年5月30日。對照組以常規呼吸訓練模式,實驗組則以常規呼吸訓練模式之外介入「WEANSNOW」評估,兩組以呼吸脫離率為成效指標,並以前、後測探討呼吸困難程度之成效,進而探討「WEANSNOW」評估項目與成功脫離呼吸器是否有關。
研究結果:應用「WEANSNOW」評估介入於呼吸器訓練脫離過程,相較於常規呼吸器脫離過程,實驗組比對照組呼吸器使用天數減少了4.95天,脫離率提高了2.5%,但兩組未達統計意義(p > .05)。兩組呼吸困難程度以配對t檢定檢測做組間比較,顯示兩組後測皆有進步且達統計上意義(p < .05)。最後發現實驗組所介入的「WEANSNOW」評估項目與脫離呼吸器與否並無相關。影響呼吸困難後測相關性因素分析發現,格拉斯哥昏迷指數越高與呼吸器使用天數越少,自我呼吸困難程度就越覺得改善,而年紀越大則自我呼吸困難感受度就越明顯。
結論:本研究發現個案格拉斯哥昏迷指數越高與呼吸器使用天數越少,則自我呼吸困難程度就越覺得改善。年紀越大則自我呼吸困難感受度就越明顯。「WEANSNOW」評估項目與脫離呼吸器與否無相關性,但多元邏輯式回歸分析發現呼吸器使用天數越久越不容易脫離呼吸器。

Background: When patient has been relying on mechanical ventilator for a long time, with the time passing by, the happenness percentage of related complication will graduately increase; furthermore, incresing the difficulty to weaning from ventilators, Therefore positive training of how to weaning from mechanical ventilators is very important.
Purpose: The purposes of this study were to explore the applying WEANSNOW to evaluate of intermeeting patients weaning from mechanical ventilators whether or not increasing the weaning percentage of mechanical ventilator improving the percentage of difficult for patient to breath. And for the discussion of the related factors that successfully weaning from mechanical ventilators from WEANSNOW. It is expected that the research findings can provide clinical care application.
Methods: The research is quasi-experimental design. The object of research is for patient who using mechanical ventilators. Study was conducted from April 1, 2022 to May 30, 2023. Experimental group and control group are proceeding pre-, post-test by degree of dyspnea, and use WEANSNOW assessment as the intervention measures for experimental group.
Results: The application of WEANSNOW to evaluate of intervention patient weaning from mechanical ventilators compare to weaning process of regular training. Although the experimental group has used ventilators to reduce 4.95 days, weaning percentage has risen 2.5% compared to control group. But two groups have not yet meet the statistical significance(p > .05). Two groups’extent of dyspnea has being found out by matching Student’s t-test examine to do comparison between groups, it shows that the post test of two groups are both improving and reach the statistical significance(p < .05). Lastly, the result has found out that the WEANSNOW’s assessment item intervened by experimental group has no relation with whether or not to weaning from mechanical ventilators. Analysis of factors affecting the post-test correlation of dyspnea found that the higher the Glasgow Coma Index and the fewer days of using a respirator, the more the self-reported dyspnea improved, and the older the patient, the more obvious the self-perceived dyspnea.
Conclusion: This study found that the higher of Glasgow coma index and the less of the days of use of mechanical ventilator, the better of self dyspnea sensitivity. The older of the age and the more obvious of the self dyspnea
sensitivity. The assessment item of WEANSNOW and whether or not weaning from mechanical ventilators have no relation but multiple logistics regression analysis has found out that the longer of the days of use of mechanical ventilators, the more difficulty to weaning from mechanical ventilators.

致謝 I
中文摘要 III
Abstract V
目錄 VIII
表次 X
圖次 X
第一章 緒論 1
第一節 研究背景與動機 1
第二節 研究目的 2
第三節 研究問題 3
第四節 研究假設 4
第五節 名詞界定 5
第二章文獻探討 6
第一節 呼吸器依賴定義、現況、與呼吸衰竭成因 6
一、呼吸器依賴定義與現況 6
二、呼吸衰竭成因探討 6
第二節 影響呼吸器脫離因素 8
第三節成功脫離呼吸器因素探討 10
一、呼吸參數(Weaning index /profile) 11
二、呼吸管管徑(Endotracheal tube/tracheostomy tube size) 11
三、體內酸鹼平衡 (Acidosis/Alkalosis) 13
四、營養評估(Nutrition status ) 13
五、呼吸道分泌物(Secretion) 14
六、神經肌肉功能之影響(Neuromuscular condition) 15
七、呼吸道阻塞(Obstruction of main airways) 16
八、清醒程度(Wakefulness) 17
第四節 呼吸器訓練脫離前準備及訓練方式 19
第五節 文獻總結 21
第三章 研究方法 22
第一節 研究架構 22
第二節 研究設計 25
第三節 研究場所及對象 28
第四節 研究實施步驟 29
第五節 研究工具 33
第六節 統計方法 35
第七節 研究倫理 38
第四章 研究結果 39
第一節 研究對象基本屬性分析 39
第二節 研究對象生理評估項目分析 43
第三節 研究對象呼吸功能評估項目 45
第四節 「WEANSNOW」評估介入對呼吸器脫離之成效 47
第五節 「WEANSNOW」評估介入對呼吸困難程度之成效 48
第七節 「WEANSNOW」評估項目與成功脫離呼吸器有無相關分析 52
第五章 討論 55
第一節 「WEANSNOW」對於呼吸器脫離率成效 55
第二節「WEANSNOW」評估於呼吸器訓練脫離過程,改善病患呼吸困難程度結果分析 56
第四節 分析「WEANSNOW」評估項目與成功脫離呼吸器是否相關 57
第六章 結論、限制、與建議 60
第一節 結論 60
第二節 研究限制 61
第三節 研究應用與建議 62
參考文獻 64
中文部分 64
英文部分 67
附錄一:研究倫理委員會通過證明 79
附錄二:改良式呼吸困難自我評量表(Modified Borg dyspnea scale,MBS) 83
附錄三、WEANSNOW check list 85
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