臺灣博碩士論文加值系統

本研究目的:探討噁心、嘔吐（post operative nausea vomiting,PONV）的相關危險因子，在恢復室照護一小時及二十四小時內，其造成病人術後發生率的危險因子是否有所不同的相關因子，利用手術麻醉病人之噁心、嘔吐評估表，使護理人員儘早預測病人術後噁心、嘔吐（post operative nausea vomiting,PONV）的發生，預防照護術後噁心、嘔吐的措施能儘早給予處置，以減輕病人不適。
方法：研究對象為中部某醫學中心醫院麻醉部恢復室手術病人，年齡以20歲以上，期間為2012年1月1日至2012年3月30止。採病歷查閱方式、橫斷式研究設計，以結構是問卷來進行資料收集，收案共300名。所得資料以SPPSS17.0中文版統計套裝軟體進行建檔分析，進行描述性統計、卡方檢定、邏吉斯迴歸之推論性分析。
結果：本研究結果發現，女性對術後恢復期噁心嘔吐危險性機率高男性，不抽煙病人對術後恢復期噁心嘔吐危險性機率高有抽煙，麻醉方式採全身麻醉對術後恢復期噁心嘔吐危險性機率高靜脈麻醉，病人對噁心嘔吐愈嚴重，其感受愈不舒適有達到顯著水準。
建議:未來研究，可以採前瞻性研究方式，進一步探討麻醉術中止痛藥與噁心、嘔吐相關性，提供作為臨床醫護之參考。

Purpose: The purpose of this study s is to investigate the factors related to post operative nausea and vomiting (PONV) for patients going through postoperative convalescence. The nausea and vomiting scale was used for patients cared in1 hour and within 24 hours in the recovery room to see if there are different elements contributing to the risk factors which cause the incidence of PONV. It is hoped that the results of this study help nursing professionals to predict when nausea and vomiting will occur and provide management to prevent PONV to reduce the discomfort of patients.
Method: The subjects of this study were 300 patients (aged over 20) operated and received anesthesia in a medical center in central Taiwan from January 1 to March 30, 2012. Clinical data were derived from medical charts. In this cross-sectional study, data were collected by a structured questionnaire and analyzed based on SPPSS17.0, descriptive statistics, Chi-square and Logistic Regression analysis.
Results: The results showed that female patients have higher hazard rate of nausea and vomiting during postoperative convalescence than males (odds ratio=0.325). Non-smokers have higher hazard rate than smokers (odds ratio=0.380). Patients with general anesthesia have higher rate than those with intravenous anesthesia (odds ratio=0.153). Significant difference was noticed between the severity of nausea/vomiting and discomfort.
Conclusion: This is a cross-sectional study with 300 subjects. It fails to know if medications and surgery duration are related to nausea and vomiting in postoperative convalescence. The limitation of this study can be solved by longitudinal studies to provide more information for clinical nursing professionals.

中文摘要
英文摘要
目錄i
表目錄iii
圖目錄iv
第一章 緒論
第一節 研究動機及重要性 1
第二節 研究目的 3
第三節 研究問題 4
第四節 研究假設 4
第二章 文獻探討
第一節 手術麻醉恢復期簡介 5
第二節 術後恢復期發生噁心、嘔吐相關因素 8
第三節 術後恢復期發生噁心、嘔吐預防措施 11
第三章 研究方法
第一節 研究設計 13
第二節 研究倫理考量 14
第三節 研究架構 15
第四節 研究之操作型定義 16
第五節 研究步驟 21
第六節 資料分析 23
第四章 研究結果
第一節 病人基本屬性手術麻醉相關因素與恢復期嘔吐之情況 25
第二節 不同病人基本屬性、手術麻醉相關因素與照護1小時及24小時之差異性 31
第三節 恢復期照護1小時及24小時與嘔吐相關之邏輯迴歸分析 46
第五章 討論、結論建議
第一節 討論 50
第二節 結論 52
第三節 研究限制 53
第四節 建議 54
參考文獻
中文文獻 56
英文文獻 57
附錄
附錄一人體試驗計畫審查通過證明書 65
附錄二 研究問卷 67

表目錄
表 2-1 術後噁心嘔吐危險因子相關研究危險因子 10
表 3-1 研究變項之操作定義與測量 18
表 4-1 病人基本屬性之分佈情形 26
表 4-2 手術麻醉相關因素之情況分佈-非連續變項分析 28
表 4-3 噁心嘔吐評估量表之分佈情形 30
表 4-4 基本屬性與照護1小時嘔吐之差異性 33
表 4-5 基本屬性與照護24小時嘔吐之差異性 36
表 4-6 手術麻醉相關因素與照護1小時嘔吐之差異性 40
表 4-7 手術麻醉相關因素與照護24小時嘔吐之差異性 44
表 4-8 恢復期照護1小時及24小時與嘔吐相關之邏輯迴歸分析 47

圖目錄
圖3-1 研究架構 15
圖3-2 研究步驟流程 22

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