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  • 學位論文

俯臥治療於急性呼吸窘迫症候群病患對預後 及生理指標的影響

Outcome and physiological effects of prone position in patients with acute respiratory distress syndrome

指導教授 : 盧美秀
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摘要


本研究目的為了解急性呼吸窘迫症候群病患人口學基本屬性、病患執行俯臥治療前後,其生理指標(心跳、呼吸、血氧及平均動脈壓)的變化差異及其預後相關性。本研究為回溯性研究設計(Retrospective Research Design),資料收集方法為病歷調查法,收案時間為2008年1月至2010年12月,收案場所為北部某教學醫院加護病房,針對加護病房內診斷為急性呼吸窘迫症候群病患進行收案,分為有執行俯臥治療及未執行俯臥治療兩組,以SPSS17.0套裝軟體進行資料分析,分析統計包括基本屬性資料的分析以百分比(percent)、平均值(mean)、中位數(median)、標準差(standard deviation)等方法;俯臥期間,不同時間點,其心跳、呼吸、血壓及血中氧含量濃度,是否有顯著差異以Wilcoxon two-sample test檢定,最後以廣義估計方程式(Generalized Estimating Equation, GEE)檢定各項生理指標與年齡、疾病嚴重度(APACHE II Score)加護病房住院天數、昏迷指數(Glasgow Coma Scale)、鎮靜藥物、俯臥頻率及俯臥時間是否有顯著差異。 研究結果顯示1.有實施俯臥的病患身上,心跳、呼吸及血壓部分俯 臥前及俯臥後有下降趨勢,血中氧含量濃度則呈現增加情形。2在俯臥病患中,以俯臥前生理指標為基準,檢定發現俯臥前與俯臥後1小時至5小時,其血中氧飽和濃度皆有顯著差異;特別是在俯臥後第3小時及第4小時,除血中氧飽和濃度外,其血壓不論是舒張壓或收縮壓皆有顯著差異。3.俯臥期間生理指標(心跳、呼吸、血壓及血中氧含量濃度)與其他變項包括年齡、疾病嚴重度(APACHE II Score)、加護病房住院天數、昏迷指數(Glasgow Coma Scale)、鎮靜藥物使用、俯臥頻率及俯臥時間是否有相關性時發現:心跳與昏迷指數(Glasgow Coma Scale)、鎮靜劑使用及俯臥時間上有顯著差異,因此心跳次數、昏迷指數及俯臥時間呈正相關;呼吸、血中氧含量濃度及血壓部分與其他變項並無相關性,顯示俯臥治療無法改變其他生理指標變項。 本研究結果可應用於臨床護理實務,協助此類病人執行俯臥治療時參考依據。

並列摘要


The aim of the study is to understand the response and prognosis before and after changing of prone position in the populations of acute respiratory distress syndrome (ARDS). Response was targeted on vital signs which was included heart rate, respiratory rate, mean arterial pressure and oxygen saturation. The study design was retrospective and collected the cases from 2008 January to 2010 December. All cases came from one of critical center of teaching hospital, located in the north of Taiwan. We collected ARDS cases and divided into 2 groups. One group was undergoing for prone position and other did not. We used SPSS17.0 software for analysis. Analysis was included percent, mean, median and standard deviation for basic data. Wilcoxon two-sample test was used to determine the variable changes of vital signs during prone position in different times. At last, Generalized Estimating Equation, GEE was applied for detection the changes of vital signs with age, APACHEII Score, durations of ICU hospitalization, Glasgow Coma Scale, usage of tranquilizer, frequency of changing position and duration of prone position. Results:1.There was improvement of vital signs (heart rate, respiratory rate, blood pressure and oxygen saturation) in the group which was undergone for prone positioning. 2.In prone position group, oxygen saturation was improved significantly after first hour to fifth hour of prone position, especially after third and fourth hour of prone position. Not only oxygen saturation but also blood pressure, included systolic and diastolic blood pressure, were improved significantly. 3.Whether vital signs during prone position depended on other variability like age, APACHE II Score, duration of ICU hospitalization, Glasgow Coma Scale , usage of tranquilizers and duration of prone position, we found that heart rate and Glasgow Coma Scale was irectly depended on the duration of prone position but respiration, oxygen saturation and blood pressure did not depend on the other variabilities. So prone position could not improve the vital signs. This study can apply as reference for clinical practice for ARDS populations.

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