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| DC 欄位 | 值 | 語言 |
|---|---|---|
| dc.contributor.advisor | 邱艷芬(Yann-Fen Chao) | |
| dc.contributor.author | Fang-Shan Li | en |
| dc.contributor.author | 李芳珊 | zh_TW |
| dc.date.accessioned | 2021-06-13T06:55:31Z | - |
| dc.date.available | 2005-08-04 | |
| dc.date.copyright | 2005-08-04 | |
| dc.date.issued | 2005 | |
| dc.date.submitted | 2005-07-27 | |
| dc.identifier.citation | American Association of Respiratory Care (1993). AARC Clinical practice guideline: Endotracheal suctioning of mechanically ventilated adults and children with artificial airways. Respiratory Care, 38(4), 500-504.
Bouma, G. J. (1995). Cerebral blood flow in severe clinical head injury. New Horizon, 3, 384-394. Brown, B., & Peeples, D. (1992). The effects of hyperventilation and lidocaine on intracranial pressure response to endotracheal suctioning. Heart & Lung, 21, 286. Brucia, J., & Rudy, E. (1996). The effects of suction cathertion and tracheal stimulation with severre brain injury. Heart & Lung, 25, 295-303. Bruya, M. (1981). Planned periods of rest in the intensive care unit: Nursing care activities and intracranial pressure. Journal of Neurosurgical Nursing, 13, 184-194. Campbell, R. S., & Branson, R. D. (1992). How ventilators provide temporary O2 enrichment: What happens when you press the 100% suction button? Respiratory Care, 37, 933-937. Carhuapoma, J. R., & Williams, M. A. (1999). Endotracheal suctioning and cerebral ischemia in traumatic brain injury: The 'phantom menace?'. Divisions of Neurosciences Critical Care, 27(12), 2843-2844. Carroll, P. (1994). Closing in on safer suctioning. Registered Nurse, 61 (5), 22-27. Celik, S. S., & Elbas, N.O. (2000). The standard of suction for patients undergoing endotracheal intubation. Intensive and Critical Care Nursing, 16, 191-198. Crosby, L. J., & Parsons, L. C. (1992). Cerebrovascular response of closed head-injured patients to a standardized endotracheal tube suctioning and manual hyperventilation procedure. Journal of Neuroscience Nursing, 24, 40-49. Cruz J., Miner, M. E., Allen, S. J., Alves, W. M., & Gennarelli, T. A. (1991). Continuous monitoring of cerebral oxygenation in acute brain injury: Assessment of cerebral hemodynamic reserve. Neurosurgery, 29, 743-747. Day,T., Wainwright, S.P., & Wilson-Barnett, J. (2001). An evaluation of a teaching intervention to improve the practice of endotracheal suctioning in intensive care units. Journal of Clinical Nursing, 10, 682-696. Day, T., & Wilson-Barnett, J. (2002). Tracheal suctioning: An exploration of nurses’ knowledge and competence in acute and high dependency ward areas. Journal of Advanced Nursing, 39(1), 35-45. Day,T., Farnell, S., & Wilon-Barnett, J. (2002). Suctioning: A review of current research recommendations. Intensive and Critical Care Nursing, 18, 79-89. deBoisblanc, B. P. ( 1999). Body position and pneumonia. Critical Care Medicine, 27(4), 678-679. deBoisblanc, B.P., Castro, M., Everret, B., Grender, J., Walker, C. D., & Summer, W. R. ( 1993). Effect of air-supported, continuous, postural oscillation on the risk of early ICU pneumonia in nontraumatic critical illness. Chest, 103(5), 1543-1547. Duric, A., Omerbegovic, M., Ajanovic, M., Mahic, Z., Alic, M., & Vanis-Vatrenjak, S. (2003). Prevention of secondary brain injuries, Medicinski Arhiv, 57(4 Suppl 1), 53-56. Gemma, M., Tommasino, C., Cerri. M., Giannotti, A., Piazzi, B., & Borghi, T. (2002). Intracranial effects of endotracheal suctioning in the acute phase of head injury. Journal of Neurological Anesthesiology, 14, 50-54. Ghajar, J. (2000). Traumatic brain injury. Brain Trauma Foundation and Weill Medical College of Cornell University. Glass, C., & Grap, M. (1995). Ten tips for safer suctioning. American Journal of Nursing, 5(5), 51-53. Grande, P. O., Asgeirsson, B., & Nordstrom, C. H. (2002). Volume-targeted therapy of increased intracrancial pressure: The Lund concept unifies surgical and non-surgical treatments. Acta Anaesthesiologica Scandinavica, 46, 929-941. Greenberg, M.S. (2001). Handbook of neurosurgery. New York: Thieme. Griggs, A. (1998).Tracheostomy: Suctioning and humidification. Nursing Standard, 13(2), 49-56. Kerr, M. E., Rudy E. B., Weber B. B., & Darby, J. (1997). Effect of short-duration hyperventilation during endotracheal suctioning on intracranial pressure in severe head-injured adults. Nursing Research, 46, 195–201. Kerr, M. E., Weber, B. B., Sereika, S. M., Darby, J., Marion, D. W., & Orndoff, P. A. ( 1999). Effect of endotracheal suctioning on cerebral oxygenation in traumatic brain-injured patients. Critical Care Medicine, 27, 2776–2781. Martin, L. (1999). All you really need to know to interpret arterial blood gases(2nd ed.), Philadelphia: Lippincott Williams &Wilkins. Mitchell, P., & Mauss, N. (1978). Relationship of patient-nurse activity to intracranial pressure variations: A pilot study. Nursing Research, 27, 4-10. Odell, A., Allder, A., & Bayne, R. (1993). Endotracheal suction for adult non-head injured patients: A review of the literature. Intensive Critical Care Nursing, 9, 274-278. Rising, C. J. ( 1993 ). The relationship of selected nursing activities to ICP. Journal of Neuroscience Nursing, 25(5), 302-308. Ropper, A. H., & Rockoff, M. A. (1993). Physiology and clinical aspects of raised intracranial pressure. In A. H. Ropper (Ed.), Neurological and neurosurgical lintensive car (pp. 11-27). New York: Raven Press. Rosner, M. J., Rosner, S. D., & Johnson, A. H. (1995). Cerebral perfusion pressure: Management protocol and clinical result. Journal of Neurosurgery, 83, 949-962. Rudy, E. B., Baun, M., Stone, K. S., & Turner, B. (1986). The relationship between endotracheal suctioning and changes in intracranial pressure: A review of the literature. Heart & Lung, 15, 488-494. Rudy, E. B., Turner, B. S., Baun, M., Stone, K. S., & Brucia, J. (1991). Endotracheal suctioning in adults with head injury. Heart & Lung, 20, 667-674. Stone, K. S., Bell, S. D., & Preusser, B. A. (1991). The effect of repeated endotracheal suctioning on arterial blood pressure. Applied Nursing Research, 4(4), 152-158. Swartz, K., Noonan, D.M., & Edwards-Beckett, J. (1996). A national survey of endotracheal suctioning techniques in the pediatric population. Heart & Lung, 25(1), 52-60. Thompson, L. (2000).Tracheal suctioning of adults with an artificial airway. The Joanna Briggs Institute for Evidence Based Nursing and Midwifery, 4(4), 1-6. Wainwright, S., & Gould, D. (1996). Endotracheal suctioning: An example of the problems of relevance and rigour in clinical research. Journal of Clinical Nursing, 5(6), 389-398. Werba, A., Klezl, M., Schramm, W., Langenecker, S., Muller, C., Gosch, M., et al. (1993). The level of neuromuscular block needed to suppress diaphragmatic movement during tracheal suction in patients with raised intracranial pressure: A study with vecuronium and atracurium. Anaesthesia, 48, 301-303. Wood, C. J. (1998). Endotracheal suctioning : A literature review. Intensive and Critical Care Nursing, 14, 124-136. Young, C. (1984). Recommended guidelines for suction. Physiotherapy , 70(3), 106-108. | |
| dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/35498 | - |
| dc.description.abstract | 抽痰是眾多護理活動中頻率很高也很常見的活動，也是最常被提及其對腦部傷患影響很大的活動，對其影響過程愈瞭解愈可以知道如何避免造成影響，本研究目的在探討急性腦傷病患在急性期氣管內管抽痰對腦組織灌流變化的影響與其相關因素，以釐清抽痰前、中、後期之灌流變化。本研究採立意取樣，收案條件為年齡在十八歲以上、腦部傷患在急性期之病患，無冠狀動脈性心臟病、鬱血性心衰竭疾病、無藥物成癮。研究對象於住院時有裝置顱內壓監視器，以隨時了解病患實際之顱內壓，在配合病程之需要下，給與標準抽痰程序。共收案位病患6位完整收集31筆資料，收案期間自93年08月至93年11月，病患於腦部受傷急性期顱內壓監視器仍留置時，每天下午與晚間會客中間或晚間會客後，沒有任何治療或護理活動，使用Manitol超過2小時，病患若有需要，由研究者於執行標準抽痰程序時，以床旁監視器監測心跳、血壓、呼吸次數與動脈血氧飽和度的在安全範疇，確保病患之安全，用儀器自動記錄血壓、顱內壓、潮氣末二氧化碳濃度、心跳、腦灌流壓及腦血流之變化，分析比較病患在執行抽痰護理活動前、中、後各時期實際數據，並加以分析。
本研究將以SPSS 12.0套裝軟體進行資料分析，研究結果發現如下： 一、準備良好的標準抽痰程序去抽痰可以先有效降顱內壓，使抽痰過程中顱內壓的上升，恢復期的斜率雖與0無異但顱內壓平均值仍低於基準值。 二、血壓仍然會上升，顱內壓回復至基準值時血壓尚需一段時間才可以下降至基準值。 三、EtCO2降低到一定程度其改變就無統計上之差異。 四、心跳仍然會上升，顱內壓回復至基準值時心跳亦很快下降至基準值。 五、腦灌流壓一定會上升，顱內壓回復至基準值時腦灌流壓仍較基準值為高。 六、腦血流是會下降，其下降程度測量值與基準值相比無統計上的差異，顱內壓回復至基準值時腦血流會較基準值為高，維持較好的血流供應。 七、鎮靜劑的使用對於顱內壓較高或是顱內壓變化較大的病患是需要的，且若病患較敏感易有咳嗽反應則應並用肌肉鬆弛劑。 本研究的結果有助於神經外科加護單位的同仁，更清楚知道，是抽痰的那些動作造成影響需加以避免，如不能免如何不造成傷害，可做為神經加護單位執行抽痰護理活動的指引，以建立最適當的照護模式。對於學校或臨床在職教育教學的內容，提供有關神經外科手術後加護照護的護理觀念，亦可引導護理人員瞭解澄清良好抽痰準備在血液動力學上的變化，加以注意不造成傷害。護理研究方面本研究是藉由床邊實地測量，以實際連續數字呈現，此種記錄方式在國內護理的研究中應為首篇，可做為相關研究的參考，應用到去瞭解其他護理活動對病患生理的瞭解中。 | zh_TW |
| dc.description.abstract | The purpose of this study was to evaluate the impact of endotracheal suctioning on intracranial dynamics in the acute phase of head injury. This study applied prospective nonrandomized research design and will include patients who admitted into neurosurgical ICU with intracranial pressure monitor (ICP monitor) in a medical center in Taipei city during August to November 2004. The researcher will visit to recruit subjects and subjects will be enrolled into investigate group after their family signing their informed consents. There were 6 Patients with 31 subjects were enrolled. During their stay in ICU, they will be suctioning when they need. Their heart rate, blood pressure, respiration rate, O2 Saturation (SpO2), ICP, EtCO2 and cerebral perfusion pressure (CPP) will be measured in the time.
The results revealed that: (1)There was significant difference between basic lining and recovery stage in ICP; (2) The BP still increased until the ICP had already recovered; (3) There was significant difference between basic lining and 1st hyperventilation stage in the changes of EtCO2; (4) The HR came back to the basic lining when the ICP had recovered; (5) The CPP was increased, when the ICP had back to the basic lining, it was still higher than the basic lining; (6) The CBF was decreased in suctioning, but the recovery stage was higher than the basic lining; (7) Sedation was useful to stabilize ICP. This study can be used as a reference for nursing staff noticed in suctioning. Health care educators may integrate the results shown in this thesis into their curriculums. To care for a IICP patient, using this evidence-based practice, nurses can offer safe and scientific suctioning intervention to patients. | en |
| dc.description.provenance | Made available in DSpace on 2021-06-13T06:55:31Z (GMT). No. of bitstreams: 1 ntu-94-R90426002-1.pdf: 1062938 bytes, checksum: 11b25cbac32ac68990c7f27dc5efe32d (MD5) Previous issue date: 2005 | en |
| dc.description.tableofcontents | 頁次
致謝 ……………………………………………………………… i 中文摘要 ……………………………………………………………… ii 英文摘要 ……………………………………………………………… v 內容目錄 ……………………………………………………………… vii 圖表目錄 ……………………………………………………………… ix 第壹章 緒論 第一節 研究動機…………………………………………………… 1 第二節 研究目的與研究問題假設………………………………… 2 第三節 名詞界定…………………………………………………… 3 第四節 研究之意義………………………………………………… 4 第五節 研究之範圍………………………………………………… 4 第貳章 文獻探討與理論架構 第一節 腦損傷的生理病理………………………………………… 6 第二節 腦損傷的治療重點………………………………………… 6 第三節 抽痰對腦灌流之影響……………………………………… 8 第四節 抽痰的方法………………………………………………… 10 第五節 研究架構…………………………………………………… 14 第參章 研究方法 第一節 研究設計…………………………………………………… 15 第二節 研究對象…………………………………………………… 15 第三節 測量………………………………………………. ……… 17 第四節 研究步驟…………………………………………………… 20 第五節 資料分析…………………………………………………… 21 第六節 研究對象的權益保護……………………………………… 22 第肆章 研究結果 第一節 研究對象基本資料………………………………………… 23 第二節 抽痰時腦部傷患顱內壓之變化…………………………… 24 第三節 抽痰時腦部傷患血壓之變化……………………………… 27 第四節 抽痰時腦部傷患潮氣末二氧化碳分壓之變化…………… 30 第五節 抽痰時腦部傷患心跳之變化……………………………… 33 第六節 抽痰時腦部傷患腦灌流壓之變化………………………… 36 第七節 抽痰時腦部傷患腦血流之變化…………………………… 39 第八節 鎮靜劑對抽痰過程顱內壓、血壓、潮氣末二氧化碳分壓、心跳及腦灌流壓之影響…………………………………… 41 第九節 抽痰全程中的變化分析…………………………………… 47 第伍章 討論 第一節 抽痰時腦部傷患顱內壓之變化與鎮靜的影響…………… 50 第二節 抽痰時腦部傷患血壓之變化與鎮靜的影響……………… 51 第三節 抽痰時腦部傷患潮氣末二氧化碳分壓之變化與鎮靜的影響…………………………………………………………… 52 第四節 抽痰時腦部傷患心跳之變化與鎮靜的影響……………… 53 第五節 抽痰時腦部傷患腦灌流壓之變化與鎮靜的影響………… 53 第六節 抽痰時腦部傷患腦血流之變化與鎮靜的影響…………… 55 第陸章 結論與建議 第一節 結論………………………………………………………… 56 第二節 護理上的應用……………………………………………… 58 第三節 研究的限制與建議………………………………………… 59 參考資料 ……………………………………………………………… 62 附錄 附錄一 試驗受試者說明及同意書………………………………… 83 附錄二 資料收集單………………………………………………… 86 附錄三 分析資料形式……………………………………………… 87 | |
| dc.language.iso | zh-TW | |
| dc.subject | 顱內壓 | zh_TW |
| dc.subject | 抽痰 | zh_TW |
| dc.subject | 腦灌流壓 | zh_TW |
| dc.subject | 急性腦傷 | zh_TW |
| dc.subject | cerebral perfusion pressure | en |
| dc.subject | intracranial pressure | en |
| dc.subject | acute head injury | en |
| dc.subject | endotracheal suctioning | en |
| dc.title | 腦部傷患在急性期抽痰對腦血流變化之影響 | zh_TW |
| dc.title | Intracranial Effects of Endotracheal Suctioning in Acute Phase of Head Injury | en |
| dc.type | Thesis | |
| dc.date.schoolyear | 93-2 | |
| dc.description.degree | 碩士 | |
| dc.contributor.oralexamcommittee | 黃勝堅(Sheng-Jean Huang),羅美芳(Meei-Fang Lou) | |
| dc.subject.keyword | 抽痰,顱內壓,腦灌流壓,急性腦傷, | zh_TW |
| dc.subject.keyword | endotracheal suctioning,intracranial pressure,cerebral perfusion pressure,acute head injury, | en |
| dc.relation.page | 87 | |
| dc.rights.note | 有償授權 | |
| dc.date.accepted | 2005-07-28 | |
| dc.contributor.author-college | 醫學院 | zh_TW |
| dc.contributor.author-dept | 護理學研究所 | zh_TW |
| 顯示於系所單位： | 護理學系所 | |
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