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  • 學位論文

急性期聽覺感官刺激對腦損傷病人顱內壓及認知功能復原之影響

指導教授 : 邱艶芬

摘要


台灣地區的事故傷害死因已從民國86年的第三位,下降至民國95年的第四位,雖然因事故傷害死亡的人數大幅降低,但是每年因輕、中度甚至嚴重頭部外傷住院治療的人數,仍是造成國內醫療及社會成本的一大負擔。對於頭部外傷的病人運用音樂治療及感官刺激,研究顯示對於其認知感官的恢復的確有所助益,有學者認為提供正確的刺激,是可以使腦損傷慢慢復原的。本篇研究希望藉由聽覺感官刺激的介入處置,在不傷害病人及過度刺激的情況下,觀察病人心跳、平均動脈壓及顱內壓改變,進而了解聽覺感官刺激對於腦損傷急性期的影響,同時加以追蹤對認知功能的復原是否有所影響。 於台北市某醫學中心之神經外科加護病房為收案地點,收案對象為有置放顱內壓監視器的腦損傷病人,隨機將其分為控制組及實驗組,實驗組於病人仍有顱內壓監視器留置期間,每日會固定進行3次長達20分鐘65分貝的聲音刺激,時間為早上0730、下午1430、晚上2030,避開治療進行時間減少其他干擾,觀察其心跳、血壓、顱內壓的改變,同時於病人損傷ㄧ、二、三個月後再進行認知功能評估,共收案24位,兩組各12位,以了解病人復原的程度。資料分析以SPSS17.0/PC版本進行資料檢定及結果判定,本研究採用描述性統計、χ2 及t-test 檢定來分析二組之同質性,以重複測量ANOVA分析聽覺刺激的反應,最後再以GEE、pair t-test及χ2來比較兩組認知功能的復原情形。 研究結果顯示,兩組病人基本屬性之間並無統計上的差異存在(p> .05),於急性期介入聽覺感官刺激不會對病人產生威脅,此項措施係屬安全可行,最後在認知功能的追蹤下,發現個案的GCS及SPMSQ並不會因組別的不同而有所差異,但是隨著時間的進程,其認知功能的復原是正向的,兩組之間雖無統計上的差異,但實驗組在得分上均高於控制組。由結果可知本研究介入措施安全性受到肯定,雖然因樣本數不足缺乏推論力,但仍建議未來可以繼續進行相關的研究,為聽覺刺激模式建立完善的執行模式,有效應用於臨床治療中。

並列摘要


In Taiwan, Injury Accident Fatal fell to No. 4 in 2006 which ranked No. 3 in 1997. Though the no. of death of injury accident fatal has reduced substantially but it is a heavy burden to domestic medical system and social costs no mater mild, moderate or serious head trauma. According to researches, to use music therapy and Sensory stimulation can benefit to the injuries of sensory recovery. Some scholars think to offer appropriate stimuli can help brain injured to recover gradually. This purpose of thesis is to use Auditory sensory stimuli to observe patients’ heartbeat, mean arterial pressure and intracranial pressure to learn if auditory sensory stimuli will cause any influence to acute brain injury and to trace if it will have any influence to the recovery of cognitive which will be taken by not cause any harm or over stimulate patients. The objected cases are the patients who have ICP monitor implanted at the Neurosurgery ICU of a Medical Center in Taipei. The cases were divided randomly in Controlled Group and Experimental Group. Cases of Experimental Group will be given 65 dB sound-stimuli in 3 times, each time will take 20 minutes as in 7:30, 14:30 and 20:30 in between daily treatment, in order to avoid interference of treatment, to observe patients’ heartbeat, blood pressure and ICP. The experiment will also evaluate Cognitive simultaneously in one-month, two-month and three-month. There are 12 cases each in two groups, total 24 cases. The purpose is to observe the patients’ recovering level and the observing data will be analyzed and examined by using SPSS 17.0/PC to get an evaluation result. This thesis uses descriptive statistics, χ2 and t-test to analyze the homogeneity of these 2 groups. And then repeated-measure ANOVA to analyze the reactions of auditory stimulus. In the last, to do a comparison of cognitive of these 2 groups by using GEE, pair t-test and χ2. As a result of the research, there, basically, is no conspicuous difference (p> .05) on statistic of 2 groups. To give patients Auditory sensory stimuli in acute period won’t cause threats to patients, so this therapy is safe and doable. The results of GCS and SPMSQ of these 2 groups are positive, however, the degree of experimental group is getting better than the other group after a long-term observation. As a result, the intervention measures of this research are positive, although the specimens are not enough and ratiocinativeless, intervention measures are suggested being used for the relevant researches in the future in order to create a maturity model of Auditory sensory stimuli and use the model in clinical treatment.

參考文獻


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被引用紀錄


林麗卿、邱艶芬、林碧珠(2017)。家屬叮嚀方案對減輕加護病人焦慮和非計畫性拔管之成效護理雜誌64(5),41-49。https://doi.org/10.6224%2fJN.000067

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