博碩士論文 etd-0607120-113847 詳細資訊


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姓名 徐曉雲(Hsiao-Yun Hsu) 電子郵件信箱 E-mail 資料不公開
畢業系所 企業管理學系醫務管理碩士班(Master of Health Care Management, Department of Business Management)
畢業學位 碩士(Master) 畢業時期 108學年第2學期
論文名稱(中) 加護病房執行病人早期復健活動之成效
論文名稱(英) The impact of Early goal-directed mobilization(EGDM) on outcomes in ICU
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    摘要(中) 加護病房重症病人因病況危重而插置氣管內管使用呼吸器以提供呼吸道支持,並放置各式侵入性導管進行積極治療及監測,因此限制病人活動並強制臥床休息。隨著急性期過後,病人因臥床不動導致肌肉萎縮、活動能力下降,嚴重者影響心肺功能,使呼吸器脫離困難,延長加護病房住院天數。本研究目的在探討加護病房執行病人早期復健活動,對於提升身體活動能力、縮短加護病房住院天數及呼吸器使用天數之成效。本研究採類實驗法以資料回溯方式,於研究醫院之成人加護病房進行研究,將病人分為實驗組I (35位)、實驗組II (33位)及對照組(52位),三組共120人。實驗組兩組依創新開發的加護病房早期復健活動(Early goal-directed mobilization, EGDM)照護流程,並以加護病房活動量表(ICU mobility scale, IMS)評估病人活動程度提供合適復健活動,實驗組I由物理治療師進行每日一次EGDM措施,實驗組II由護理師及物理治療師進行每日兩次EGDM,對照組未實施EGDM僅實施常規照護。資料收集透過電子病歷收集2016年1月1日至2019年12月31日三組病人資料,以卡方檢定、獨立樣本t檢定、配對樣本t檢定、單因子變異數分析、迴歸分析等統計方法進行分析。研究結果:與對照組比較,實驗組I與實驗組II的加護病房呼吸器使用天數及加護病房住院天數未達顯著差異;介入不同方案EGDM,實驗組I及實驗組II於復健期間前後比較IMS均有進步,而實驗組II 之IMS進步分數較實驗組I為多;介入不同方案EGDM,比較實驗組I及實驗組II復健期間第一次IMS兩組間無差異,而復健期間最後一次IMS則為實驗組II較實驗組I進步程度顯著;實驗組(實驗組I與實驗組II)之IMS進步分數越多,加護病房呼吸器使用天數越短;實驗組(實驗組I與實驗組II)之IMS進步分數越多,加護病房住院天數縮短,但未達統計上顯著差異。結論:介入EGDM與提升重症病人身體活動能力(IMS)及縮短加護病房呼吸器使用天數相關,而加護病房住院天數則需要更多的研究探討以證實其成效。
    摘要(英) Background and Aim: The critical patients who stay in intensive care unit (ICU) are usually suffered from insertion of endotracheal tube and ventilator support because of serious illness and the need of airway protection. In addition, they also have some invasive catheters on the bodies for close monitoring. These instruments and the usage of sedative drugs limit their muscle activity and ability passively. As we known, bed-ridden for a long time will cause muscle atrophy, decrease activity of extremities with negative effects on their cardiovascular function in this kind of patients. It also increases the possibility of difficult ventilator weaning and extended staying in ICU. Hence, implementing the early goal-directed mobilization (EGDM), a novel rehabilitation program, in these patients in ICU may be one of the solution for resolving these problems. The aim of this research is to evaluate the impact of EGDM on the increase of activity, shortening days of staying and using ventilator in ICU.
    Methods: This study reviewed the adult patients who receiving critical care in ICU in a medical center retrospectively. A total of 120 patients were enrolled for analysis and were divided into three groups: group I (n=35), group II (n=33) and control group (n=52). The EGDM in once daily would be conducted in patients of group I by physical therapists. The EGDM in twice daily would be conducted in patients of group II by registered professional nurses and physical therapists. The patients of control group received bed-side care without EGDM implementation. The patients’s activity and ability would be evaluated by the ICU mobility scale (IMS).The medical information of the three groups of patients were collected from Jan 1st,2016 to Dec 31st, 2019. The statistical analysis used Chi-square test, independent and paired sample T-tests, and logistic regression analysis.
    Results: Compared to the control group, the days of using ventilator and staying in ICU did not achieve significant difference between the patients in group I and II. However, improvement of IMS were both achieved in group I and II. Furthermore, the IMS of group II was more improved than of group I. Although the IMS revealed no significant difference in both groups during the first course of EGDM, The IMS of group II achieved significant improvement than of group I in the last EGDM program. In addition, the more IMS improved, the less days of ventilator dependent achieved. The more IMS score improved, the trend of less staying in ICU achieved.
    Conclusion: implementing the EGDM is associated with increase the IMS for critical patients in ICU and shorten the days of ventilator usage. But days of staying in ICU needs more research to confirm its effectiveness.
    關鍵字(中)
  • 加護病房、早期復健活動、身體活動能力
  • 關鍵字(英)
  • intensive care unit
  • ICU mobility scale.
  • early goal-directed mobilization
  • 論文目次 論文審定書 i
    致謝 ii
    中文摘要 iii
    Abstract iv
    目錄 vi
    圖目錄 viii
    表目錄 ix
    第一章 緒論 1
    第一節 研究背景、重要性及動機 1
    第二節 研究目的 3
    第二章 文獻查證 4
    第一節 重症病人制動之影響 4
    第二節 早期復健活動之相關探討 7
    第三節 加護病房呼吸器使用天數相關探討 14
    第四節 加護病房住院天數相關探討 18
    第三章 研究方法 22
    第一節 研究架構 23
    第二節 研究假設 25
    第三節 研究對象與場所 26
    第四節 研究步驟 28
    第五節 變數測量 33
    第六節 研究倫理 35
    第七節 資料分析與統計 36
    第四章 研究結果 38
    第一節 研究對象之基本資料分析 39
    第二節 實驗組與對照組加護病房呼吸器使用天數之差異分析 45
    第三節 實驗組與對照組加護病房住院天數之差異分析 46
    第四節 實驗組不同復健方案的介入對IMS之影響 47
    第五節 IMS分數的增加對於加護病房呼吸器使用天數之影響 49
    第六節 IMS分數的增加對於加護病房住院天數之影響 50
    第五章 討論與建議 51
    第一節 討論與建議 52
    第二節 研究限制與建議 62
    第六章 結論 64
    參考文獻 65
    附錄一 加護病房病人早期復健活動照護流程 72
    附錄二 加護病房活動量表(ICU mobility scale, IMS) 73
    附錄三 人體研究倫理審查委員會-人體研究計畫同意函 74
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    31. Zang, K., Chen, B., Wang, M., Chen, D., Hui, L., Guo, S.,…Shang, F. (2019). The effect of early mobilization in critically ill patients: A metaanalysis. Nurs Crit Care, 1–8. DOI: 10.1111/nicc.12455
    口試委員
  • 伍麗珠 - 召集委員
  • 李英俊 - 委員
  • 葉淑娟 - 指導教授
  • 口試日期 2020-06-24 繳交日期 2020-07-07

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