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  • 學位論文

探討外科加護病房環境改善於預防譫妄及睡眠品質之成效

Effects of environmental modification on delirium and sleep in SICU patients

指導教授 : 黃正宜 廖玟君
本文將於2025/01/01開放下載。若您希望在開放下載時收到通知,可將文章加入收藏

摘要


譫妄(Delirium)是加護病房常見之合併症,為急性短時間認知損傷症狀。睡眠障礙是譫妄病患的共同感受,其中以環境聲音與光照為主要誘發原因。本研究目的為探討外科加護病房環境改善於預防譫妄及睡眠品質之成效。本研究採時間前後對照研究設計,研究場所為中部某醫學中心外科加護病房,選取20歲以上成人、昏迷指數15分及在加護病房待超過24小時之病患。樣本數各39位,措施介入前為對照組(平均年齡54.31 ± 15.1),措施介入後再收集實驗組(平均年齡56.51 ± 16.1),實驗組的介入措施於每天晚上11點至隔日早上6點依據譫妄照護指引進行照護,包括:降低環境噪音分貝、調整周圍環境照度與放置時鐘等,二組連續第一天至第三天期間,以基本資料表及VSH品質問卷收集資料,再由白班及小夜班主護填寫中文版CAM-ICU,並收集第一天至第三天11PM-6AM期間亮度及音量每10分鐘之變化且於第二、三、四天早上填寫VSH品質問卷收集資料。使用SPSS統計軟體進行卡方、t檢定、重複測量及迴歸分析了解加護病房內譫妄發生率與環境因素與睡眠品質之相關性。研究結果得知對照組介入前音量為54.7~70.5(dB),介入後為40.6~44.1(dB);介入前光線變化為208~230(Lux),介入後為44~53(Lux);介入前對照組譫妄發生率(25.6%),介入後實驗組譫妄發生率(2.6%);睡眠品質部分,介入前對照組睡眠總分(平均451分),介入後實驗組睡眠總分(平均945分);採邏輯斯迴歸分析得知睡眠量表每增加100分,可降低58%發生譫妄的風險(p<.05,CI:.212∼.827)。由以上結果顯示譫妄照護指引介入可降低加護病房音量及光線變化,病患整體睡眠品質高於對照組,睡眠是譫妄發生的重要因子。希望經此結果能提供重症單位改善環境因素提升病患睡眠品質以達到預防譫妄發生,並期望能將此結果平行推展至其他醫療院所進而提升護理品質。

關鍵字

瞻妄 睡眠品質

並列摘要


The most common complication in ICU patients is acute delirium alone with sleep disturbance. Environmental noise and light could be the major causes on delirium and sleep disturbance in ICU. The purpose of this study was to investigate the effect of an Environmental Modification Program (EMP) on delirium and sleep in SICU patients. A pre-post comparison study design was performed at the ICUs of a medical center in Taichung. Patients who were adults (20 years old or older), with a Glasgow Coma Scale of 15, and stayed in ICU more than 24 hours were recruited (n=39 before and after program implementation, respectively). The EMP includes decreasing sound and light level during night time and placing clocks in each room for orientation. Delirium was assessed twice per day by using the CAM-ICU(Confusion Assessment Method for use in intensive care unit patients). Sleep perception was assessed in the 2nd to 4th day morning by using the Chinese version of the Verran and Snyder-Halpern Sleep Scale (VSH). Data of sound and light measures from 23:00 pm to 6:00 am for three nights were collected every 10 minutes. Chi-square, t test and regression analysis were used to analyze delirium incidence and relevant environmental factors on delirium and quality of sleep in patients in the ICUs. Results show that sound and light level were decreased from 54.7~70.5 dB and 208~230 lux to 40.6~44.1 dB and 44~53 lux after EMP implantation, respectively. Sleep quality were improved (VSH 451 vs. 945) and delirium incidence was decreased (25.6% vs 2.6%) after EMP. The risk of delirium was decreased 58% if sleep can be improved every 100 VSH score (p<.05,CI:.212∼.827). Implantation of EMP to lower down light and noise level in ICU has effects on improving sleep quality and decreasing delirium risk. Improving environmental factors in ICUs can reduce the incidence of delirium and poor sleep and hence to enhance the quality of care in patients in ICUs.

並列關鍵字

delirium sleep quality

參考文獻


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