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標題: | 重症病人角膜磨損發生率與相關因子 The incidence and risk factors of corneal abrasion in critically ill patients |
作者: | Chia-Ling Li 李佳玲 |
指導教授: | 戴玉慈(Yu-Tzu Dai) |
關鍵字: | 眼,重症病人,角膜磨損,加護病房,重症護理, eye,corneal abrasion,intensive care unit,critical care, |
出版年 : | 2014 |
學位: | 碩士 |
摘要: | 背景:加護病房重症病人會因為疾病或治療需要接受鎮靜治療導致意識改變,使自身角膜防衛能力降低有角膜磨損風險。
目的:探討重症病人角膜磨損發生率及角膜磨損之相關危險因子。 方法:於102年6月至103年6月收案期間,在某醫學中心之內科加護病房收集93位符合收案條件的重症病患,使用鈷藍筆燈及2% Fluorescein角膜螢光染劑,進行一周二次角膜磨損篩檢,以觀察法及結構式記錄表收集資料,收集個案角膜磨損狀況及其個人基本資料作分析。 結果:收案93位病人中,發生角膜磨損有25位,發生率26.9%(25/93)。眼部發生磨損的平均時間是在入加護病房後第12.8天,角膜磨損的危險因子是:(1)入住時GCS≦7分(χ^2=14.13,P<0.001)、(2)RASS-1~-4分(χ^2=30.64, P<0.001)、(3)眼瞼閉合能力不全者(χ^2=20.22, P<0.001)、(4)閉合時上下眼瞼間隙有間隙者(χ^2=16.75, P<0.001)、(5)使用鎮定劑者(χ^2=7.90, P<0.05)及(6)使用肌肉鬆弛劑者(χ^2=5.17, P<0.05)較易發生角膜磨損。以邏輯斯迴歸分析結果顯示RASS及閉合時上下眼瞼間隙為角膜磨損預測因子。 結論:眼部角膜磨損發生在使用呼吸器超過24小時的重症病人的比率超過四分之一,值得重視,顯示使用簡單的工具即具有偵測效果,若能及早發現,立即處理,根據事後觀察初期眼角膜磨損可以很快恢復。 Background: Critically ill patients in the ICU are in an altered state of consciousness due to disease or sedative treatment and have a reduced ability for corneal protection, leading to an increased risk of corneal abrasion. Objective: The incidence rate and risk factor correlation of corneal abrasion in critically ill patients will be examined. Methods: A total of 93 critically ill patients admitted to the ICU in one hospital from June 2013 to June 2014 were screened twice a week by using a cobalt blue light and 2% fluorescein solution. Observational methods and collected structured patient data (condition of corneal abrasion and personal data of patients) were analyzed. Results: Out of a total of 93 patients, corneal abrasion occurred in 25 (26.9%). The mean time for development of abrasion after admission to ICU was 12.8 days, and risk factors for corneal abrasion were the following: (1) Glasgow coma scale (GCS) score of 7 or lower at time of admission (χ^2=14.13, P<0.001), (2) Richmond agitation-sedation scale (RASS) score from- 1 to -4 (χ^2=30.64, P<0.001), (3) insufficient ability to close eyes (χ^2=20.22, P<0.001), (4) a gap between upper and lower eyelids when eyes are closed (χ^2=16.75, P<0.001), (5) use of sedatives (χ^2=7.90, P<0.05), and (6) use of muscle relaxants (χ^2=5.17, P<0.05). A logistic regression analysis showed RASS and gap between the eyelids when closing the eyes are predictors of corneal abrasion. Conclusions: Corneal abrasion occurs in over a quarter of critically ill patients who use a ventilator longer than 24 hours, showing that the use of simple tools has notable observable effects on detecting abrasion early. Based on follow-up observations, early detection and treatment of corneal abrasion can lead to faster recovery. |
URI: | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/55994 |
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顯示於系所單位: | 護理學系所 |
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