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完整後設資料紀錄
DC 欄位 | 值 | 語言 |
---|---|---|
dc.contributor.advisor | 戴玉慈(Yu-Tzu Dai) | |
dc.contributor.author | Shu-Hua Lu | en |
dc.contributor.author | 呂淑華 | zh_TW |
dc.date.accessioned | 2021-06-15T02:43:15Z | - |
dc.date.available | 2014-09-15 | |
dc.date.copyright | 2009-09-15 | |
dc.date.issued | 2009 | |
dc.date.submitted | 2009-08-10 | |
dc.identifier.citation | 中文部份
張玉坤(1996).GEE之敏感度分析-偵測高影響之觀察值.中華公共衛生雜誌, 15(5),403-410。 施智源、陳瀅淳、劉美芳(2007).美國疾病管制中心2004年院內感染定義中譯.感染控制雜誌,17(1),11-44。 鄭茉莉、張樹棠(2007).主、次診斷及主、次處置擇取.於鄭茉莉、張樹棠編著, ICD-9-CM分類規則彙編(第二版,47-64頁).台北市:台灣病歷管理協會。 英文部分 Adam, H. M. (1996). Fever and host responses. Pediatrics in Review, 17(9), 330-331. Allison, J. J., Wall, T. C., Spettell, C. M., Calhoun, J., Fargason, C. A., Jr., Kobylinski, R. W., et al. (2000). The art and science of chart review. Joint Commission Journal on Quality Improvement, 26(3), 115-136. American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference: definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. (1992). Critical Care Medicine, 20(6), 864-874. Arbo, M. J., Fine, M. J., Hanusa, B. H., Sefcik, T., & Kapoor, W. N. (1993). Fever of nosocomial origin: etiology, risk factors, and outcomes. American Journal of Medicine, 95(5), 505-512. Banks, N. J. (1998). Designing medical record abstraction forms. International Journal for Quality in Health Care, 10(2), 163-167. Blatteis, C. M. (1988). Temperature Regulation in Special Situations. In C. M. Blatteis (Ed.), Physiology and Pathophysiology of Temperature Regulation (1st ed., pp. 259-270). SingaporeWorld Scientific Blatteis, C. M. (2003). Fever: pathological or physiological, injurious or beneficial? Journal of Thermal Biology, 28(1), 1-13. Bor, D. H., Makadon, H. J., Friedland, G., Dasse, P., Komaroff, A. L., & Aronson, M. D. (1988). Fever in hospitalized medical patients: characteristics and significance. Journal of General Internal Medicine, 3(2), 119-125. Bradley, S. F., Kluger, M. J., & Kauffman, C. A. (1987). Age and protein malnutrition: effects on the febrile response. Gerontology, 33(2), 99-108. Broom, M. (2007). Physiology of fever. Paediatric Nursing, 19(6), 40-44. Bruce, J. L., & Grove, S. K. (1992). Fever: pathology and treatment. Critical Care Nurse, 12(1), 40-49. Burns, N., & Grove, S. K. (2001). The practice of nursing research: conduct, critique, & utilization (4th ed.). Philadelphia Saunders. Buchanan, J. B., Peloso, E., & Satinoff, E. (2006). Influence of ambient temperature on peripherally induced interleukin-1 beta fever in young and old rats. Physiology & Behavior, 88(4-5), 453-458. Castle, S. C., Norman, D. C., Yeh, M., Miller, D., & Yoshikawa, T. T. (1991). Fever response in elderly nursing home residents: are the older truly colder? Journal of the American Geriatrics Society, 39(9), 853-857. Castle, S. C., Yeh, M., Toledo, S., Yoshikawa, T. T., & Norman, D. C. (1993). Lowering the temperature criterion improves detection of infections in nursing hom residents. Aging Immunology Infection Disease, 4, 67-76. Charlson, M. E., Pompei, P., Ales, K. L., MacKenzie, C. R., Charlson, M. E., Pompei, P., et al. (1987). A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. Journal of Chronic Diseases, 40(5), 373-383. Charlson, M., Szatrowski, T. P., Peterson, J., & Gold, J. (1994). Validation of a combined comorbidity index. Journal of Clinical Epidemiology, 47(11), 1245-1251. Chesnutt, B. K., & Zamora, M. R. (2008). Blood cultures for febrile patients in the acute care setting: too quick on the draw? Journal of the American Academy of Nurse Practitioners, 20(11), 539-546. Circiumaru, B., Baldock, G., & Cohen, J. (1999). A prospective study of fever in the intensive care unit. Intensive Care Medicine, 25(7), 668-673. Commichau, C., Scarmeas, N., & Mayer, S. A. (2003). Risk factors for fever in the neurologic intensive care unit. Neurology, 60(5), 837-841. Cooper, K. E. (1995). Thermoregulation an outline. In K. E. Cooper (Ed.), Fever and Antipyresis: the Role of the Nervous System (1st ed., pp. 13-35). New York Cambridge University Press. Cooper, K. E. (1998). Thermoregulation in the elderly. In B. CM (Ed.), Physiology and Pathophysiology of Temperature Regulation (1st ed., pp. 162-172). Singapore: World Scientific. Darowski, A., Najim, Z., Weinberg, J., & Guz, A. (1991). The febrile response to mild infections in elderly hospital inpatients. Age & Ageing, 20(3), 193-198. Deyo, R. A., Cherkin, D. C., & Ciol, M. A. (1992). Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. Journal of Clinical Epidemiology, 45(6), 613-619. Downton, J. H., Andrews, K., & Puxty, J. A. (1987). 'Silent' pyrexia in the elderly. Age & Ageing, 16(1), 41-44. Extermann, M., Overcash, J., Lyman, G. H., Parr, J., & Balducci, L. (1998). Comorbidity and functional status are independent in older cancer patients. Journal of Clinical Oncology, 16(4), 1582-1587. Finkelstein, M. S., Petkun, W. M., Freedman, M. L., & Antopol, S. C. (1983). Pneumococcal bacteremia in adults: age-dependent differences in presentation and in outcome. Journal of the American Geriatrics Society, 31(1), 19-27. Florez-Duquet, M., Peloso, E., & Satinoff, E. (2001). Fever and behavioral thermoregulation in young and old rats. American Journal of Physiology - Regulatory Integrative & Comparative Physiology, 280(5), R1457-1461. Gavazzi, G., Mallaret, M.-R., Couturier, P., Iffenecker, A., & Franco, A. (2002). Bloodstream infection: differences between young-old, old, and old-old patients. Journal of the American Geriatrics Society, 50(10), 1667-1673. Gilbert, E. H., Lowenstein, S. R., Koziol-McLain, J., Barta, D. C., & Steiner, J. (1996). Chart reviews in emergency medicine research: Where are the methods? Annals of Emergency Medicine, 27(3), 305-308. Gleckman, R., & Hibert, D. (1982). Afebrile bacteremia. A phenomenon in geriatric patients. JAMA, 248(12), 1478-1481. Gould, D. (1993). Homeostasis: the key to normal function. In S. M. Hinchliff, S. E. Norman & J. E. Schober (Eds.), Nursing practice and health care (2nd ed.). London E. Arnold. Henker, R., & Shaver, J. (1994). Understanding the febrile state according to an individual adaptation framework. AACN Clinical Issues in Critical Care Nursing, 5(2), 186-193. Henker, R. (1999). Evidence-based practice: fever-related interventions. American Journal of Critical Care, 8(1), 481-487; quiz 488-489. Henker, R., & Carlson, K. K. (2007). Fever: applying research to bedside practice. AACN Advanced Critical Care, 18(1), 76-87. Hess, D. R. (2004). Retrospective studies and chart reviews. Respiratory Care, 49(10), 1171-1174. Holtzclaw, B. J. (1992). The febrile response in critical care: state of the science. Heart & Lung, 21(5), 482-501. Holtzclaw, B. J. (1999). Temperature regulation: Fever treatment. In J. C. M. G. M. Bulechek (Ed.), Nursing Interventions: Effective Nursing Treatments (3rd ed., pp. 356-366). Philadelphia: W. B. Saunders Co. Holtzclaw, B. J. (2001). HIV-Related Febrile Shivering: Effects of a Theory-Based Intervention. Paper presented at the Sigma Theta Tau International, Beta Delta Chapter, Annual Program Meeting. Holtzclaw, B. J. (2002). Use of thermoregulatory principles in patient care: fever management. Online Journal of Clinical Innovations, 5(5), 1-64. Holtzclaw, B. J. (2003). Alterations in thermoregulation. In V. Carrieri-Kohlman, A. M. Lindsey & C. M. West (Eds.), Pathophysiological Phenomena in Nursing (3rd ed ed., pp. 15-34.). Philadelphia: Saunders. Horan, T. C., & Gaynes, R. P. (2004). Surveillance of noscomial infections. In M. C.G (Ed.), Hospital Epidemiology and infection Control (3rd ed., pp. 1659-1702). Philadelphia: Lippincott Williams & Wikins. Hotchkiss, R. S., & Karl, I. E. (2003). The pathophysiology and treatment of sepsis. New England Journal of Medicine, 348(2), 138-150. Hughes, W. T., Armstrong, D., Bodey, G. P., Bow, E. J., Brown, A. E., Calandra, T., et al. (2002). 2002 guidelines for the use of antimicrobial agents in neutropenic patients with cancer. Clinical Infectious Diseases, 34(6), 730-751. Jones, P. G., Kauffman, C. A., Bergman, A. G., Hayes, C. M., Kluger, M. J., & Cannon, J. G. (1984). Fever in the elderly. Production of leukocytic pyrogen by monocytes from elderly persons. Gerontology, 30(3), 182-187. Katz, J. N., Chang, L. C., Sangha, O., Fossel, A. H., & Bates, D. W. (1996). Can comorbidity be measured by questionnaire rather than medical record review? Medical Care, 34(1), 73-84. Kauffman, C. A. (1986). Endogenous pyrogen/interleukin-1 production in aged rats. Experimental Gerontology, 21(2), 75-78. Kauffman, C. A., Jones, P. G., & Kluger, M. J. (1986). Fever and malnutrition: endogenous pyrogen/interleukin-1 in malnourished patients. American Journal of Clinical Nutrition, 44(4), 449-452. Kauffman, R. E., & Nelson, M. V. (1992). Effect of age on ibuprofen pharmacokinetics and antipyretic response. Journal of Pediatrics, 121(6), 969-973. Kieszak, S. M., Flanders, W. D., Kosinski, A. S., Shipp, C. C., & Karp, H. (1999). A comparison of the Charlson comorbidity index derived from medical record data and administrative billing data. Journal of Clinical Epidemiology, 52(2), 137-142. Kilpatrick, M. M., Lowry, D. W., Firlik, A. D., Yonas, H., & Marion, D. W. (2000). Hyperthermia in the neurosurgical intensive care unit. Neurosurgery, 47(4), 850-855; discussion 855-856. Kothari, V. M., & Karnad, D. R. (2005). New onset fever in the intensive care unit. Journal of the Association of Physicians of India, 53, 949-953. Krabbe, K. S., Bruunsgaard, H., Hansen, C. M., Moller, K., Fonsmark, L., Qvist, J., et al. (2001). Ageing is associated with a prolonged fever response in human endotoxemia. Clinical & Diagnostic Laboratory Immunology, 8(2), 333-338. Le Blanc, L., Lesur, O., Valiquette, L., & St-Pierre, C. (2006). Role of routine blood cultures in detecting unapparent infections during continuous renal replacement therapy. Intensive Care Medicine, 32(11), 1802-1807. Lee, C.-C., Chen, S.-Y., Chang, I. J., Chen, S.-C., & Wu, S.-C. (2007). Comparison of clinical manifestations and outcome of community-acquired bloodstream infections among the oldest old, elderly, and adult patients. Medicine, 86(3), 138-144. Librero, J., Peiro, S., & Ordinana, R. (1999). Chronic comorbidity and outcomes of hospital care: length of stay, mortality, and readmission at 30 and 365 days. Journal of Clinical Epidemiology, 52(3), 171-179. Liu, M., Domen, K., & Chino, N. (1997). Comorbidity measures for stroke outcome research: a preliminary study. Archives of Physical Medicine & Rehabilitation, 78(2), 166-172. Lu, S. H., & Dai, Y. T. (2009). Normal body temperature and the effects of age, sex, ambient temperature and body mass index on normal oral temperature: A prospective, comparative study. International Journal of Nursing Studies, 46(5), 661-668. Mackowiak, P. A., & Boulant, J. A. (1997). Fever's Upper Limit. In P. A. Mackowiak (Ed.), Fever : basic mechanisms and management (2nd ed., pp. 147-164). New York Lippincott-Raven. Mackowiak, P. A. (1998). Concepts of fever. Archives of Internal Medicine, 158(17), 1870-1881. McGowan, J. E., Jr., Rose, R. C., Jacobs, N. F., Schaberg, D. R., & Haley, R. W. (1987). Fever in hospitalized patients. With special reference to the medical service. American Journal of Medicine, 82(3 Spec No), 580-586. Munoz, P., Cruz, A. F., Rodriguez-Creixems, M., & Bouza, E. (2008). Gram-negative bloodstream infections. International Journal of Antimicrobial Agents, 32 Suppl 1, S10-14. Norman, D. C., Castle, S. C., & Cantrell, M. (1987). Infections in the nursing home. Journal of the American Geriatrics Society, 35(8), 796-805. Norman, D. C., Castle, S., Yamamura, R. H., & Yoshikawa, T. T. (1995). Interrelationship of fever, immune response and aging in mice. Mechanisms of Ageing & Development, 80(1), 53-67. Norman, D. C., & Yoshikawa, T. T. (1996). Fever in the elderly. Infectious Disease Clinics of North America, 10(1), 93-99. Norman, D. C. (2000). Fever in the elderly. Clinical Infectious Diseases, 31(1), 148-151. Ochroch, E. A., & Fleisher, L. A. (2006). Retrospective analysis: looking backward to point the way forward. Anesthesiology, 105(4), 643-644. O'Grady, N. P., Barie, P. S., Bartlett, J. G., Bleck, T., Carroll, K., Kalil, A. C., et al. (2008). Guidelines for evaluation of new fever in critically ill adult patients: 2008 update from the American College of Critical Care Medicine and the Infectious Diseases Society of America. Critical Care Medicine, 36(4), 1330-1349. Peloso, E. D., Florez-Duquet, M., Buchanan, J. B., & Satinoff, E. (2003). LPS fever in old rats depends on the ambient temperature. Physiology & Behavior, 78(4-5), 651-654. Peres Bota, D., Lopes Ferreira, F., Melot, C., & Vincent, J. L. (2004). Body temperature alterations in the critically ill. Intensive Care Medicine, 30(5), 811-816. Pizzo, P. A. (1999). Fever in immunocompromised patients. New England Journal of Medicine, 341(12), 893-900. Polit, D. F., & Beck, C. T. (2004). Analyzing Quantitative Data: Inferential Statistics. In D. F. Polit & C. T. Beck (Eds.), Nursing research : principles and methods (7th ed., pp. 477-510). Philadelphia: Lippincott Williams & Wilkins. Roy, C. W. (1988). An Inter-Rater Reliability Study of the Barthel Index. International Journal of Rehabilitation Research, 11(1), 67-70. Roghmann, M. C., Warner, J., & Mackowiak, P. A. (2001). The relationship between age and fever magnitude. American Journal of the Medical Sciences, 322(2), 68-70. Robinson, E. L., & Fuller, C. A. (2000). Gravity and thermoregulation: metabolic changes and circadian rhythms. Pflugers Archiv - European Journal of Physiology, 441(2-3 Suppl), R32-38. Rubin, R. H., & Fishman, J. A. (1997). Fever in the immunocompromised patient. In P. A. Mackowiak (Ed.), Fever : basic mechanisms and management (2nd ed., pp. 383-400). New York Lippincott-Raven. Scarpace, P. J., Borst, S. E., & Bender, B. S. (1992). The association of E. coli peritonitis with an impaired and delayed fever response in senescent rats. Journal of Gerontology, 47(4), B142-145. Scarpace, P. J., Matheny, M., Bender, B. S., & Borst, S. E. (1992). Impaired febrile response with age: role of thermogenesis in brown adipose tissue. Proceedings of the Society for Experimental Biology & Medicine, 200(3), 353-358. Shah, S., Vanclay, F., & Cooper, B. (1989). Improving the sensitivity of the Barthel Index for stroke rehabilitation. Journal of Clinical Epidemiology, 42(8), 703-709. Smith, L. S. (2003). Using low-tech thermometers to measure body temperatures in older adults. A pilot study. Journal of Gerontological Nursing, 29(11), 26-33. Smith, M. A., Nitz, N. M., & Stuart, S. K. (2006). severity and comorbidity. In R. L. Kane (Ed.), Understanding health care outcomes research (2nd ed., pp. 219-263). Sudbury, Mass. : Jones and Bartlett. Strijbos, P. J., Horan, M. A., Carey, F., & Rothwell, N. J. (1993). Impaired febrile responses of aging mice are mediated by endogenous lipocortin-1 (annexin-1). American Journal of Physiology, 265(2 Pt 1), E289-297. Swenson, B. R., Hedrick, T. L., Popovsky, K., Pruett, T. L., & Sawyer, R. G. (2007). Is fever protective in surgical patients with bloodstream infection? Journal of the American College of Surgeons, 204(5), 815-821; discussion 822-813. Taffett, G. E. (2003). Physiology of Aging. In C. K. Cassel (Ed.), Geriatric medicine : an evidence-based approach (4th ed., pp. 27-35). New York Springer. Tal, S., Guller, V., Gurevich, A., & Levi, S. (2002). Fever of unknown origin in the elderly. Journal of Internal Medicine, 252(4), 295-304. Thompson, H. J. (2005). Fever: a concept analysis. Journal of Advanced Nursing, 51(5), 484-492. Wade, D. T., & Hewer, R. L. (1987). Functional abilities after stroke: measurement, natural history and prognosis. Journal of Neurology, Neurosurgery & Psychiatry, 50(2), 177-182. Waterer, G. W., & Wunderink, R. G. (2001). Increasing threat of Gram-negative bacteria. Critical Care Medicine, 29(4 Suppl), N75-81. Wongsurawat, N., Davis, B. B., & Morley, J. E. (1990). Thermoregulatory failure in the elderly. St. Louis University Geriatric Grand Rounds. Journal of the American Geriatrics Society, 38(8), 899-906. Worster, A., & Haines, T. (2004). Advanced statistics: understanding medical research review (MRR) studies. Academic Emergency Medicine, 11(2), 187-192. Wu, L., & Ashton, C. M. (1997). Chart review. A need for reappraisal. Evaluation & the Health Professions, 20(2), 146-163. Wunderlich, C. A., & Reeve, J. C. (1869). The course of the temperature in disease: a guide to clinical thermometry American Journal Medicine Science, 57, 425-447. Yoshikawa, T. T., & Norman, D. C. (1998). Fever in the elderly. Infections in Medicine 15(10), 704-708. | |
dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/44172 | - |
dc.description.abstract | 背景:
發燒是感染的重要徵象,然而臨床上某些個案身受感染,卻缺乏明顯發燒反應,稱之模糊鈍化發燒反應,可能因此而延誤診斷及治療。而關於影響發燒反應的研究,多以老化或年齡為主軸進行探究。關於非年齡因素僅止於論述性敘說缺乏實證性研究。故本研究以發燒反應病理生理機制及體溫調節機轉為理論依據,探討身體遭受急性感染時,影響發燒反應之相關因素。 目的: 確立影響發燒反應即感染開始期體溫與發燒強度之相關因素。 設計: 採回溯性、重複測量、比較和相關預測的設計。 方法: 研究計劃通過倫理委員會審議後,以北部某醫學中心的感染控制中心為資料庫,回溯2007.01.01 ~ 2008. 6.30之住院病人經血液培養結果陽性,確認院內血流感染者為潛在研究對象,以臨床醫療病歷作為資料來源,自擬病歷資料萃取單為研究工具,以白血球數量、年齡、共病症嚴重度(查爾森合併症指數)、身體活動功能(巴氏指數)、營養狀態(體重、身體質量指數)及菌種類型(血液細菌培養結果)為自變項;探討其對發燒反應的影響,所得結果運用SPSS 15.0版統計軟體分析,以描述性統計呈現個案基本屬性及發燒參數資料分佈,再以t-檢定、單因子變異數分析、雙變項相關分析、回歸分析及廣義線性模式確立影響發燒反應相關因素。 結果: 經隨機選樣獲得個案600位,最終有效樣本230位,個案屬性以男性居多(58.8%),年齡自18至94歲,主要診斷以腫瘤最多(46.1%),排名前四類的感染菌種是克雷白氏肺炎菌、金黃色葡萄球菌、大腸桿菌及念珠菌屬。體溫基礎值平均為36.33°C(S.D. 0.32°C),具性別差異性,但不具年齡差異性。感染開始期體溫平均值為38.33°C,感染開始期體溫< 38°C者有48位,佔總個案數20.86% (48/230);多元回歸分析結果白血球數量、共病症嚴重度、體重、菌種類型此4個變項僅能聯合預測感染開始期體溫7.4%的變異量。本研究顯示87.3%(n=199)個案,在感染期間僅有1次發燒事件,考慮時間因素使用廣義估計方程式分析結果顯示白血球數量、年齡、查爾森合併症指數、與菌種類型為影響發燒強度顯著性因子。 結論與建議: 本研究以臨床資料為基礎,非僅單一考量年齡因素,納入學理上可能影響因素一同分析,結果發現白血球數量、年齡、合併症嚴重度、身體活動、體重、菌種類型對發燒反應在統計上皆有顯著的影響,由於發燒反應是一種複雜的生理適應反應,因此有許多疑點需要未來研究繼續澄清,尤其是白血球數量與發燒強度之關係方向性;本研究結果可提供臨床觀察急性感染患者發燒反應強弱重要評估參考,並作為未來發燒反應前瞻性研究之基礎,延伸護理研究於深入生理變項及生物護理研究範疇。 關鍵字:發燒反應、院內血流感染、感染開始期體溫、發燒強度、病歷回顧 | zh_TW |
dc.description.abstract | Background:
Fever is considered a hallmark sign of infection; however, some patients suffer from infection without manifesting a febrile response. Blunted febrile response can delay diagnosis and treatment and thus result in higher mortality. Most studies have focused on the influence of aging on the febrile response. Few empirical studies of febrile response have addressed non-age-related factors. Therefore this study was based on pathophysiological mechanism of febrile response and body temperature thermoregulation, and explored the factors that affect the febrile response to hospital acquired bloodstream infection. Purpose: The aims of this study were to examine factors that affect febrile response including temperature at the onset, and magnitude of fever. Design: The study used a retrospective, repeated measures, comparison, correlational and predictive design. Method: After obtaining ethics committee approval, the investigator used an infection control database of a university hospital in Taipei to select random sample of 600 medical records of bloodstream infection cases reported on patients hospitalized between January 1, 2007 to June 30, 2008. Research instrument was chart abstraction form designed by the author. The independent variables were white blood cell count (WBC), age, severity of co-morbidity (Charlson Comorbidity Index), physical function (Barthel Index), nutritional status (body weight, body mass index, and albumin), and microbial classification (blood culture results). To determine the factors that affect febrile response SPSS 15.0 statistical software package was used to analyze the data. The investigator used descriptive statistics to characterize the demographics and fever parameters of the sample cases. T-tests, ANOVA, Pearson correlation, multiple regression and General Estimating Equation (GEE) were used to analyze the predictive factors. Results: The cases ranged from 18 to 94 years old, 58.8% were male and 46.1% had a primary diagnosis of cancer. The top four categories of identified pathogens were staphylococcus aureus, Escherichia coli, klebsiella pneumoniae and candida spp. The mean baseline temperature was 36.33°C (SD 0.32°C). Although women had slightly higher baseline temperatures compared to men, there was no difference related to age. The mean temperature at the onset of fever was 38.33°C (SD 0.77°C); 48 cases (20.86%) had temperature at the onset lower than < 38°C. Multiple regression analysis results indicated white blood cell count, severity of co-morbidity, body weight, and microbial classification were significant predictors of temperature at the onset. However, these factors predicted only 7.4% of the variance. GEE analysis demonstrated white blood cell count, age, severity of co-morbidity, physical function and microbial classification were significant predictors of the magnitude of fever. Most cases (87.3%) had only one fever episode related to their hospital acquired bloodstream infection episode. Conclusions and suggestion: The findings revealed that white blood cell count, age, severity of co-morbidity, physical function, body weight, and microbial classification have different effects on the febrile response. Febrile response is a complex biophysical adaption. For the reason many issues need to be continued investigating in the future. Especially in the relationship between white blood cell count and magnitude of fever is need to research. The findings of the study can provide clinical practitioners information to use the parameters of fever response to assess febrile patients, and can establish the base for prospective studies of the biophysical factors related to fever responses. Key words: febrile response, nosocomial bloodstream infection, temperature at the onset, magnitude of fever, chart review | en |
dc.description.provenance | Made available in DSpace on 2021-06-15T02:43:15Z (GMT). No. of bitstreams: 1 ntu-98-D92426005-1.pdf: 1194862 bytes, checksum: 411a9bff1324b28cb9919c73043d5216 (MD5) Previous issue date: 2009 | en |
dc.description.tableofcontents | 目 錄
口試委員會審定書………………………………………………… i 誌謝………………………………………………………………… ii 中文摘要…………………………………………………………… iv 英文摘要…………………………………………………………… vi 目錄………………………………………………………………… ix 表目錄……………………………………………………………… xii 圖目錄……………………………………………………………… xiv 第一章 緒論……………………………………………………… 001 第一節 研究背景與重要性……………………………………… 001 第二節 研究問題………………………………………………… 005 第三節 研究目的………………………………………………… 005 第二章 文獻查證………………………………………………… 006 第一節 體溫調節………………………………………………… 006 第二節 發燒反應………………………………………………… 009 第三節 影響發燒反應的相關因素……………………………… 014 第四節 院內血流感染…………………………………………… 033 第五節 病歷回溯研究法………………………………………… 036 第三章 研究方法………………………………………………… 044 第一節 研究設計………………………………………………… 044 第二節 研究對象及場所………………………………………… 044 第三節 研究概念架構…………………………………………… 047 第四節 名詞定義………………………………………………… 048 第五節 研究工具………………………………………………… 056 第六節 信度與效度……………………………………………… 072 第七節 研究步驟………………………………………………… 079 第八節 資料分析………………………………………………… 080 第九節 倫理考量………………………………………………… 084 第四章 研究結果………………………………………………… 085 第一節 個案基本屬性及疾病治療資料………………………… 085 第二節 體溫基礎值及相關的影響因素………………………… 095 第三節 感染開始期體溫及相關的影響因素…………………… 101 第四節 感染期間發燒強度及相關的影響因素………………… 113 第五章 討論……………………………………………………… 134 第一節 影響體溫基礎值之相關因素…………………………… 134 第二節 影響感染開始期體溫之相關因素……………………… 136 第三節 影響感染期間發燒強度之相關因素…………………… 143 第六章 結論及建議……………………………………………… 147 第一節 結論……………………………………………………… 147 第二節 研究貢獻………………………………………………… 149 第三節 研究限制與未來研究建議……………………………… 151 參考文獻………………………………………………………… 153 中文部份………………………………………………………… 153 英文部分………………………………………………………… 153 附錄……………………………………………………………… 164 附錄一 資料萃取單……………………………………………… 165 附錄二 體溫變項萃取常見Q & A……………………………… 187 附錄三 國立台灣大學醫學院附設醫院倫理委員會同意書…… 191 附錄四 常態分布檢定莖葉圖…………………………………… 194 表 目 錄 表3-4-1 研究變項測量與資料收集工具………………………… 055 表3-6-1 資料萃取者間一致性信度測試結果分析……………… 075 表3-6-2 資料萃取者內一致性信度測試結果分析……………… 077 表3-8-1 資料分析方法一覽表…………………………………… 083 表4-1-1 未納入個案原因分析一覽表…………………………… 087 表4-1-2 基本資料………………………………………………… 088 表4-1-3 主要疾病及診斷分類…………………………………… 089 表4-1-4 病人單位來源屬性分析………………………………… 090 表4-1-5 疾病治療相關資料……………………………………… 092 表4-1-6 血流感染致病菌種分類………………………………… 094 表4-2-1 不同體溫基礎值取得方式之個案數分佈及平均體溫值 096 表4-2-2 不同定義方式取得體溫基礎值之單因子變異數分析… 097 表4-2-3 不同年齡之體溫基礎值比較分析……………………… 098 表4-2-4 不同性別之體溫基礎值比較分析……………………… 099 表4-3-1 影響感染開始期體溫之相關因素分析………………… 104 表4-3-2 各變項對感染開始期體溫之迴歸分析摘要表………… 105 表4-3-3 影響感染開始期體溫之變項多元迴歸分析摘要表…… 106 表4-3-4 迴歸分析共線性診斷表………………………………… 108 表4-4-1 隨時間推移每日體溫最高值的變化分析……………… 117 表4-4-2 各變項對感染期間每日體溫最高值之影響GEE分析… 118 表4-4-3 感染期間每日體溫最高值之影響因子GEE分析……… 119 表4-4-4 不同年齡之每日體溫最高值多重比較分析…………… 120 表4-4-5 不同程度身體活動功能之每日體溫最高值多重比較… 121 表4-4-6 不同菌種類型之每日體溫最高值之多重比較………… 122 表4-4-7 革蘭氏陽性菌感染隨時間推移每日體溫改變量的變化 123 表4-4-8 革蘭氏陰性菌感染隨時間推移每日體溫改變量的變化 124 表4-4-9 念珠菌感染隨時間推移每日體溫改變量的變化……… 125 表4-4-10 隨時間推移每日體溫改變量的變化分析…………… 126 表4-4-11 研究結果摘要表……………………………………… 127 圖 目 錄 圖2-1-1 體溫恆定回饋機制……………………………………… 008 圖2-3-1 老化過程中恆定維持力減縮趨勢圖…………………… 016 圖2-3-2 影響發燒反應相關因素………………………………… 032 圖3-3-1 研究概念圖……………………………………………… 047 圖4-2-1 體溫基礎值與年齡關係散佈圖………………………… 100 圖4-3-1 感染開始期體溫與白血球數量關係散佈圖…………… 109 圖4-3-2 感染開始期體溫與年齡關係散佈圖…………………… 109 圖4-3-3 感染開始期體溫與共併症嚴重度關係散佈圖………… 110 圖4-3-4 感染開始期體溫與身體活動功能關係散佈圖………… 110 圖4-3-5 感染開始期體溫與體重關係散佈圖…………………… 111 表4-3-6 感染開始期體溫與身體質量指數關係散佈圖………… 111 圖4-3-7 感染開始期體溫與血清白蛋白關係散佈圖…………… 112 圖4-4-1 隨時間推移每日體溫最高值變化趨勢………………… 128 圖4-4-2 不同年齡隨時間推移每日體溫最高值變化趨勢……… 129 圖4-4-3 不同菌種類型隨時間推移每日體溫最高值變化趨勢… 130 圖4-4-4 隨時間推移每日體溫改變量之變化趨勢……………… 131 圖4-4-5 不同年齡隨時間推移每日體溫改變量之變化趨勢…… 132 圖4-4-6 不同菌種類型隨時間推移每日體溫改變量之變化趨勢 133 | |
dc.language.iso | zh-TW | |
dc.title | 影響發燒反應之相關因素研究:以院內血流感染患者為例 | zh_TW |
dc.title | A study on factors that affect the febrile response in patients with nosocomial bloodstream infection | en |
dc.type | Thesis | |
dc.date.schoolyear | 97-2 | |
dc.description.degree | 博士 | |
dc.contributor.oralexamcommittee | 張玉坤(Yue-Cune Chang),陳宜君(Yee-Chun Chen),莊人祥(Jen-Hsiang Chuang),嚴崇仁(Chung-Jen Yen) | |
dc.subject.keyword | 發燒反應,院內血流感染,感染開始期體溫,發燒強度,病歷回顧法, | zh_TW |
dc.subject.keyword | febrile response,nosocomial bloodstream infection,temperature at the onset,magnitude of fever,chart review, | en |
dc.relation.page | 199 | |
dc.rights.note | 有償授權 | |
dc.date.accepted | 2009-08-10 | |
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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