- 期刊
目標溫度管理之概念分析
Target Temperature Management: A Concept Analysis
摘要
目標溫度管理（target temperature management, TTM）為將人體體溫降低至目標溫度的管理方式以減少器官組織之傷害。最早於1940年開始運用在心臟停止及腦創傷（traumatic brain injury, TBI）病人。從早期研究至今，此法多應用於到院前心跳停止，經急救恢復心跳但意識狀態仍呈現昏迷的病人。許多證據顯示目標溫度管理的降溫策略，對腦損傷具有保護神經及降低缺血缺氧再灌流損傷所導致的細胞死亡，可達到降低腦及器官組織之傷害及心肌細胞保護之作用，本文運用Walker和Avant所提出之概念分析步驟，文獻查證後定義此概念為將中樞體溫管理控制於攝氏32－34℃的目標溫度維持12－72小時後可緩慢執行回溫。其前置因素為年齡18歲以上，非外傷導致的心室顫動或是無脈搏的心室心博過速所造成的心跳停止；經急救復甦恢復心跳後血流動力學維持穩定但是意識狀態仍然呈現昏迷的病人。造成後果為降低腦部葡萄糖和氧氣的代謝以及血液再灌注所造成的腦損傷，並列出實證性相關資料、舉出典型案例、邊緣案例及相反案例以澄清此概念，目的在使醫護人員對「目標溫度管理」概念能更清楚及正確的運用於臨床照護與護理研究。
並列摘要
Target temperature management, defined as a management to reduce the body temperature to meet a target temperature in order to reduce the damages of organs and tissues. In early 1940, it began to be treated on the patients with cardiac arrest or traumatic brain injury. From early studies to date, this method is frequently used to rescue the comatose adult patients upon return of spontaneous circulation after out-of-hospital cardiac arrest with an initial shockable rhythm. The evidences showed that the target temperature management for brain injury could protect the cranial nerve and reduce the death of cells with hypoxic-ischemic and reperfusion injury. It can mitigate the damages of brain and organs, and protect myocardial tissues. This study based on the concept analysis method proposed by Walker and Avant, and characterized the target temperature management as central temperature of the patents controlled in the target temperature of 32-34℃ for 12-24 hours and to slowly make the body temperature return. The antecedents referring to the patient who is aged over 18 years old and has been resuscitated after cardiac arrest due to ventricular fibrillation or nonperfusing ventricular tachycardia as the initial cardiac rhythm, a presumed cardiac origin of the arrest. The target temperature management could reduce energy failure and ischemia and reperfusion injury. This concept analysis presents the empirical data of target temperature management, and uses the examples of typical cases, borderline cases, and contrary cases, to clarify the concept further. Findings may provide nursing staff with an understanding of the concept of target temperature management in clinical practice and nursing research.