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  • 學位論文

姿勢改變對無體外循環冠狀動脈繞道手術病患脫離呼吸器前後氧合功能及舒適程度之影響

Effects of position changes on oxygenation and comfort level in patients undergoing off-pump coronary artery bypass surgery before and after their weaning from mechanical ventilator

指導教授 : 黃秀梨

摘要


姿勢改變為臨床上重要護理措施。心臟手術後病患姿勢改變會影響氧合弁鄐庰徆A程度,對術後恢復有重要影響。國內外文獻缺乏脫離呼吸器前後姿勢改變對病患氧合弁鄐庰徆A程度影響之相關研究。本研究目的在探討姿勢改變(床頭高度0∘、30∘、60∘)對無體外循環冠狀動脈繞道手術病患脫離呼吸器前後氧合弁鄐庰徆A程度之影響。研究採類實驗法,以單一實驗組進行橫斷式研究,於一家醫學中心心臟血管外科加護中心,立意取樣法選取30位無體外循環冠狀動脈繞道手術病患為研究對象,收案期間從92年10月至93年3月,於病患住進加護中心2小時後及脫離呼吸器2~16小時內,收集病患脫離呼吸器前後姿勢改變(床頭高度0∘、30∘、60∘)對氧合弁鄐尬v響,以脈衝式血氧飽合濃度(SpO2)、動脈血氧分壓(PaO2)、呼吸次數(RR)、心跳次數(HR)、動脈收縮壓(SABP)、動脈舒張壓(DABP)、平均動脈壓(MABP)及混合靜脈血氧飽合濃度(SVO2)為指標;並以病人自覺的視覺類比量表(VAS)及護理人員主觀評估的臉部表情量表(Happy face-sad face scale)來評估病患舒適程度。 研究結果發現,病患脫離呼吸器前不同床頭高度氧合弁鄐霅情A呼吸次數(RR)呈顯著差異,床頭高度60∘時,呼吸次數較床頭高度0∘快;動脈收縮壓(SABP)亦呈顯著差異,但經Scheffe法事後比較發現床頭高度0∘、30∘、60∘間之差異則未呈統計差異。此外病患脫離呼吸器後不同床頭高度,氧合弁鄎

並列摘要


Position-change is an important clinical nursing procedure. Position-change in post-cardiac surgical patients can affect their oxygenation function and comfort level, and has a big influence on post-operative recovery. Up to now, there are few studies of influence of position-change on the patients’ oxygenation function and comfort levels before and after their weaning from the ventilator. This study is to investigate the influence of position-change (head of bed elevated to 0∘,30∘, 60∘) on oxygenation function and comfort level of off-pump coronary artery bypass graft patients before and after their weaning from ventilator. This is a quasi-experimental study. Thirty patients, who underwent off-pump coronary artery bypass grafting in a medical center during the period from October 2003 to March 2004, were prospectively collected for this study. Within 2 hours after their admission to intensive care unit for postoperative care, we did “before the weaning” study, and during the period between 2 hours and 16 hours after the extubation, we did “after the weaning” study. The study investigated the influence of position-change (head of bed elevated to 0∘,30∘, 60∘) on different aspects of oxygenation, including pulse oxymetry (SpO2), arterial blood oxygen tension (PaO2), respiratory rate (RR), heart rate (HR), systolic arterial blood pressure (SABP), diastolic arterial blood pressure (DABP), mean arterial blood pressure (MABP), and mixed venous blood oxygen saturation (SvO2). We also evaluated the patients’ comfort levels by visual analog scale (VAS) and happy-face-sad-face scale. The study revealed significant change of respiratory rate at different degrees of bed-head elevation before the ventilator weaning. Respiratory rates were significantly higher when the patients’ bed-heads were elevated to 60∘compared to 0∘. Systolic arterial blood pressure had significant difference among different degrees of bed-head elevation, however, Sheff’s method found no statistical difference between each pair of bed-head elevation degrees. After the ventilator weaning, position-change did not significantly influence oxygenation function. No matter before or after the ventilator weaning, comfort levels evaluated by VAS by the patients themselves or by happy-face-sad–face scales by nursing staff, showed significant difference at different degree of bed-head elevation. Comfort levels at bed-head elevation at 60∘were worse than those at 0∘or 30∘, but there is no difference between 0

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