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  • 學位論文

口腔護理方案於呼吸器相關性肺炎高危險群病患之成效探討

The effect of an oral care plan on patients at risk for ventilator-associated pneumonia

指導教授 : 蔡仁貞

摘要


本研究旨在了解執行口腔護理方案於呼吸器相關性肺炎﹙ventilator- associated pneumonia, VAP﹚高危險群病患之成效探討,研究為隨機實驗性研究,共收集50位符合條件病患為對象,以SPSS 15.0統計軟體之Independent Sample t-test、Fisher’s exact test、Log-rank test、Generalized Estimating Equation、Logistic regression、Linear stepwise regression、Multiple regression with stepwise procedure進行資料分析。 研究結果如下:VAP發生率於實驗組(n = 24)為2.41‰,對照組(n = 26)則為2.43‰。實驗組與對照組在「使用呼吸輔助器天數」未達顯著差異(t = .56, p = .58);另外實驗組與對照組在「加護病房住院天數」也未達顯著差異(t = .46, p =.65)。 對於牙菌斑清除成效,兩組在第1天的牙菌斑分數有顯著差異(B = .35, Wald χ2 = 5.70, p = .017),且實驗組平均分數(M = 2.74)顯著高於對照組(M = 2.39),在第6天(B = -1.47, Wald χ2 = 45.50, p < .001)、第11天(B = -2.02, Wald χ2 = 95.61, p < .001)、第16天(B = -2.37, Wald χ2 = 50.34, p < .001)與第21天(B = -2.34, Wald χ2 = 28.14, p < .001)皆達顯著差異。 兩組受試者在菌種差異性,因為發生個案數偏少無法進行推論統計分析。所有的基本變項及疾病屬性對於VAP皆無顯著的預測力(p > .05)。 本研究結果可以了解口腔護理方案對於呼吸器相關性肺炎病患無法顯著降低VAP發生(p = .99),然刷牙可以有效清除牙菌斑(p < .001),提升口腔衛生,本研究結果提供臨床醫療護理人員對於執行口腔護理方案於呼吸器相關性肺炎高危險群病患,臨床照護之參考。

並列摘要


The purpose of this study to perform oral care plan for ventilator associated pneumonia (VAP) on high risk patients, and to confer its effectiveness. The research was a randomized experimental study, and 50 eligible cases were collected as the object. The research applied SPSS 15.0 statistical software of Independent Sample t-test, Fisher's exact test, Log-rank test, Generalized Estimating Equation, Logistic regression, Linear stepwise regression, and Multiple regression with stepwise procedure for data analysis. The following was the results: the incidence of VAP in the experimental group (n = 24) was 2.41 ‰; the control group (n = 26) was 2.43 ‰. No difference was found in the duration of mechanical ventilator between groups (t = .56, p = .58). There were no significant differences in length of ICU stay between the experimental group and the control group (t =. 46, p =. 65). The effectiveness of dental plaque removed between groups in the first day had significant differences in dental plaque score (B = .35, Wald χ2 = 5.70, p = .02), and the experimental group average scores (M = 2.74) was significantly higher (M = 2.39) than the control group: Day 6 (B = -1.47, Wald χ2 = 45.50, p= .02), Day 11 (B = -2.02, Wald χ2 = 95.61, p ﹤.001), Day 16 (B = -2.37, Wald χ2 = 50.34, p < .001) and Day 21 (B = -2.34, Wald χ2 = 28.14, p < .001) had significant decline. It showed that the experimental group, from the first day, to Day 6, Day 11, Day 16, and Day 21, had more declines in dental plaque than the control group. The bacteria causative of VAP detected in this study had few cases, thus was unable to carry on the deduction inferential statistics. All the basic properties of variables and disease attribute for VAP had no significant predictors (p > .05). The results of this study which was to understand oral care plan for high risk patients had no significant decrease in VAP occurrence, but had a significant decrease in dental plaque score. It showed that brushing teeth could affectively remove dental plaque and improve oral health. This research provides nursing staff the implementation of an oral care plan for the VAP high risk patients for reference.

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