- 學位論文
探討影響使用非侵襲性正壓呼吸器患者顏面壓力性損傷之相關因素：回溯病例對照研究
Associated Factors of Facial Pressure Injury in Patients under Non-Invasive Positive Ventilation: A retrospective case control study
摘要
背景: 非侵襲性正壓呼吸器是急慢性呼吸衰竭患者的治療方式之一，早期使用非侵襲性正壓呼吸器治療對於患者的預後改善至關重要，它已被證實可以降低插管率以及重新置放率，然而非侵襲性正壓呼吸器是引起醫療器材相關壓力性損傷的來源之一，其中最嚴重的合併症是與病人皮膚接觸壓力最大的部位發生皮膚潰瘍。皮膚潰瘍的存在會影響病人身心的痛苦和不適，除了延長住院時間和增加醫療成本的支出以外，亦增加照護的成本及影響護理品質，且皮膚損傷的發生亦會降低皮膚界面的耐受性和使用非侵襲性呼吸器的成功率。 目的: 本研究旨在探討影響使用非侵襲性正壓呼吸器患者顏面壓力性損傷的預測因子。 方法: 採回溯病例對照研究(A retrospective case control study)，是一種回溯性研究設計 (Retrospective study)。於2018年1月1日至2020年10月30日共計收案423人，排除26人，最後納入397人。研究工具為基本人口學特性及疾病特性資料表、壓瘡高危險因子評估量表(Braden Scale)、以及急性生理及慢性健康評估系統評分表（Acute Physiology and Chronic Health Evaluation II）。研究對象的基本資料以次數、百分比、平均數及標準差分析；顏面壓力性損傷發生率、壓傷分級及發生部位，以次數及百分比呈現；獨立樣本t檢定(independent sample t-test)及皮爾森卡方檢定(Pearson's chi-squared test)分析有發生顏面壓力性損傷組與無發生顏面壓力性損傷組之間的差異；並以羅吉斯迴歸分析 (Logistic regression)檢驗使用非侵襲性正壓呼吸器患者發生顏面壓力性損傷之預測因子。 結果:顏面壓力性損傷的發生率為10.07% (40/397)，發生部位以鼻樑7.30% (29/397) 佔最高，損傷分級則以1級51.72% (15/29) 的發生率佔最高。在基準值，兩組的基本資料和疾病特性以獨立樣本t檢定結果發現，年齡 (p= .043)、白蛋白 (p= .001)、身體質量指數(BMI) (p= .001)、疾病嚴重度(p= .008)、壓瘡危險因子分數 (p= .001)、住加護病房天數(p= .001)以及使用非侵襲性正壓呼吸器天數(p= .001)達顯著差異；此外，基準值時兩組的基本資料和疾病特性以卡方檢定結果在類固醇使用(p= .013)、C反應蛋白(p= .008)、身體質量指數( BMI) (p= .002)、疾病嚴重度(p= .012)、壓瘡危險因子分數 (p= .001)、住加護病房天數(p= .001)和使用非侵襲性正壓呼吸器天數(p= .001) 達顯著差異。羅吉斯迴歸模式 (Logistic regression)分析影響顏面損傷發生的預測變項，壓瘡危險因子分數，勝算比值(odds ratio; OR)為1.630 (95% CI=1.176¬¬–2.259 ) (p= .003)、類固醇使用，OR= .349 (95% CI=.159–1.811) (p= .008)、身體質量指數，OR= .396 (95% CI=.210–.748 ) (p= .004)，達顯著差異，為使用非侵襲性正壓呼吸器發生顏面壓力性損傷之預測因素。 結論與建議:由本研究結果得知，非侵襲性正壓呼吸器發生顏面壓力性損傷的預測因子為壓瘡危險因子分數越高、有類固醇藥物使用以及身體質量指數越低，越容易有顏面壓力性損傷發生。本研究結果提供臨床照護者在非侵襲性正壓呼吸器發生顏面壓力性損傷的在職教育參考，以提升臨床照護者正確的認知，期許能降低使用非侵襲性正壓呼吸器發生顏面壓力性損傷的發生。
並列摘要
Background: Noninvasive positive pressure ventilator (NIPPV) is one of the treatments of patients with acute or chronic respiratory failure. Early use of noninvasive positive pressure ventilator improves the disease prognosis, which decreases the intubation rate. Medical Device-Related Pressure Injury resulting from NIPPV which is the one of the most serious complications causing skin breakdown. The impact of pressure injuries will lead to both physical and psychological pain and discomfort during hospitalization. In addition, pressure injuries also extend the length of hospital stay and increase medical expenses and nursing care time allocation. Skin integrity also affects the success rate of using NIPPV. Objective: The purpose of this study was to investigate factors associated with facial pressure injury (FPI) in patients undergoing non-invasive positive ventilation (NIPPV) during hospitalization and to identify predictors of FPI. Methods: This study was a retrospective case control study. A total of 423 cases were accepted from January 1, 2018 to October 30, 2020, with 26 cases excluded and 397 cases finally included. Demographic characteristics data, clinical disease data, Braden Scale (Braden Scale) and Acute Physiology and Chronic Health Evaluation II (Acute Physiology and Chronic Health Evaluation II) were used to data collection. The demographic data were analyzed by frequency, percentage, mean and standard deviation. The incidence rate, grade and location of facial pressure injury were presented in terms of frequency and percentage. The difference between the group with and without facial pressure injury was analyzed by an independent sample t-test. The differences of category variables between the group with and without facial pressure injury were analyzed by Pearson's Chi-Squared test. Logistic regression analysis was used to examine predictors of facial pressure injury in patients using NIPPV. Results: The mean age of patients were 79.76 (± 12.76) years, male n = 231(58.19%) and female 166 (41.81%). The incidence of facial pressure injury was 10.07% (40/397), with 7.30% (29/397) at the nasal bridge, and 51.72% (15/29) at grade 1. Independent t-tests showed significant differences between the two groups with respect to baseline age (p= .043), serum albumin data (p = .001), body mass index (BMI) (p = .001), disease severity (p = .008), Braden Scale score (p = .001), length of intensive care unit stay (p= .001), and days of NIPPV use (p = .001); Chi-square test showed significant differences in steroid use (p = .013), C-reactive protein (C-RP) (p = .008), body mass index (BMI) (p = .002), disease severity (p = .012), Braden Scale score (p = .001), length of intensive care unit stay (p= .001), and days of NIPPV use (p = .001). Logistic regression analysis showed that the risk factor of pressure ulcer (Braden Scale score)[OR = 1.630, 95% CI= ( 1.176–2.259)], BMI [OR = .396, 95% CI= ( .210– .784)] and steroid use [OR = .394, 95% CI= ( .159–1.811)] were predictors of FPI in NIPPV. Conclusions and Recommendations: NIPPV is a treatment for patients with acute and chronic respiratory failure. However, FPI may occur due to unsuitable/inappropriate masks and discomfort in contact with the skin surface. The results of this study were that predictors of FPI in NIPPV patients were high-risk factors for pressure ulcer (Braden Scale score), steroid use, and body mass index, which were predictors of facial pressure injury in NIPPV. This study provides medical staff with the information needed to enhance their continuing education on predictors of FPI in NIPPV to improve their knowledge to reduce FPI.
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延伸閱讀
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