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| DC 欄位 | 值 | 語言 |
|---|---|---|
| dc.contributor.advisor | 戴玉慈(Yu-Tzu Dai) | |
| dc.contributor.author | Chia-Ling Li | en |
| dc.contributor.author | 李佳玲 | zh_TW |
| dc.date.accessioned | 2021-06-16T05:12:32Z | - |
| dc.date.available | 2019-10-09 | |
| dc.date.copyright | 2014-10-09 | |
| dc.date.issued | 2014 | |
| dc.date.submitted | 2014-08-18 | |
| dc.identifier.citation | 褚仁遠. (2005). 眼病學. 臺北市: 宏欣文化.
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Retrieved July 13, 2014 from http://web.a.ebscohost.com/dynamed/detail?vid=3&sid=b494c9e9-962d-490d-903d2786453d3f42%40sessionmgr4005&hid=4214&bdata=JnNpdGU9ZHluYW1lZC1saXZlJnNjb3BlPXNpdGU%3d#db=dme&AN=115957 Ezra, D. G., Chan, M. P. Y., Solebo, L., Malik, A. N. J., Healy, M., & Coombes, A. (2005). Randomised Control Trial Comparing the Effectiveness of Methylcellusose Eye Dressings (Geliperm) and Ocular Lubricants in the Prevention of Exposure Keratopathy in the Critically Ill. Iovs, 46, ARVO E-abstract 2024. http://onlinelibrary.wiley.com/o/cochrane/clcentral/articles/100/CN-00599100/frame.html Ezra, D.G., Healy, M., & Coombes, A. (2005). Assessment of corneal epitheliopathy in the critically ill. Intensive Care Medicine, 31(2), 313-313. doi: 10.1007/s00134-004-2518-8 Grixti, A., Sadri, M., Edgar, J., & Datta, A. V. (2012). Common Ocular Surface Disorders in Patients in Intensive Care Units. 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Eye & Contact Lens, 21(4), 221-232. Lenart, SB, & Garrity, JA. (2000). Eye care for patients receiving neuromuscular blocking agents or propofol during mechanical ventilation. American Journal of Critical Care, 9(3), 188-191. Marshall, A. P., Elliott, R., Rolls, K. D., Schacht, S., & Boyle, M. (2008). Eyecare in the critically ill: Clinical practice guideline. Australian Critical Care, 21(2), 97-109. doi: 10.1016/j.aucc.2007.10.002 McClellan, K. A. (1997). Mucosal defense of the outer eye. Survey of Ophthalmology, 42(3), 233-246. McHugh, J., Alexander, P., Kalhoro, A., & Ionides, A. (2008). Screening for ocular surface disease in the intensive care unit. Eye, 22(12), 1465-1468. doi: 10.1038/sj.eye.6702930 Mercieca, F., Suresh, P., Morton, A., & Tullo, A. (1999). Ocular surface disease in intensive care unit patients. Eye, 13(2), 231-236. doi: 10.1038/eye.1999.57 Nichols, K. K., Mitchell, G. L., & Zadnik, K. (2004). The Repeatability of Clinical Measurements of Dry Eye. Cornea, 23(3), 272-285. Oh, E. G., Lee, W. H., Yoo, J. S., Kim, S. S., Ko, I. S., Chu, S. H., . . . Kang, S. W. (2009). Factors related to incidence of eye disorders in Korean patients at intensive care units. Journal of Clinical Nursing, 18(1), 29-35. doi: 10.1111/j.1365-2702.2008.02388.x Parkin, B., Turner, A., Moore, E., & Cook, S. (1997). Bacterial keratitis in the critically ill. British Journal of Ophthalmology, 81(12), 1060-1063. doi: 10.1136/bjo.81.12.1060 Rosenberg, Jamie B. M. D., & Eisen, Lewis A. M. D. (2008). Eye care in the intensive care unit: Narrative review and meta-analysis. Critical Care Medicine December, 36(12), 3151-3155. Saritas, T. B., Bozkurt, B., Simsek, B., Cakmak, Z., Ozdemir, M., & Yosunkaya, A. (2013). Ocular Surface Disorders in Intensive Care Unit Patients. Scientific World Journal, 2013(1), 1-6. doi: 10.1155/2013/182038 Schwiegerling, Jim. (2004). Cornea: SPIE Press. Sivasankar, S., Jasper, S., & Simon, S. (2006). Eye care in ICU. Indian Journal Critical Care Medicine, 10(1), 11-14. So, H.M., Lee, C. C. H., Leung, A. K. H., Lim, J. M. J. A., Chan, C. S. C., & Yan, W. W. (2008). Comparing the effectiveness of polyethylene covers (Gladwrap™) with lanolin (DuratearsR) eye ointment to prevent corneal abrasions in critically ill patients: A randomized controlled study. International Journal of Nursing Studies, 45(11), 1565-1571. doi: http://dx.doi.org/10.1016/j.ijnurstu.2008.02.005 Suresh, P., Mercieca, F., & Morton, A. (2000). Eye care for the critically ill. Intensive Care Medicine 26, 162-166. Upadhyay, M. P., Karmacharya, P. C., Koirala, S., Shah, D. N., Shakya, S., Shrestha, J. K., . . . Whitcher, J. P. (2001). The Bhaktapur eye study: ocular trauma and antibiotic prophylaxis for the prevention of corneal ulceration in Nepal. British Joural of Ophthalmol, 85(4), 388-392. doi: 10.1136/bjo.85.4.388 Werli-Alvarenga, A., Ercole, F. F., Herdman, T. H., & Chianca, T. C. M. (2013). 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| dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/55994 | - |
| dc.description.abstract | 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。 | zh_TW |
| dc.description.abstract | 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. | en |
| dc.description.provenance | Made available in DSpace on 2021-06-16T05:12:32Z (GMT). No. of bitstreams: 1 ntu-103-R98426019-1.pdf: 1121097 bytes, checksum: 7c45e7117ccf041bd2830daf9cd8e62b (MD5) Previous issue date: 2014 | en |
| dc.description.tableofcontents | 口試委員會審訂書 I
誌謝 II 中文摘要 III ABSTRACT IV 表目錄 VIII 圖目錄 IX 第一章緒論 1 第一節研究動機與重要性 1 第二節研究目的 3 第三節研究假設 4 第四節名詞界定 5 第二章文獻查證 7 第一節眼球表面保護機制 7 第二節重症病人角膜磨損可能原因、發生率及危險因子 11 第三節重症病人角膜完整性篩檢 14 第四節重症病人的眼部護理方式及其對角膜磨損之影響 16 第三章研究方法 20 第一節研究設計 20 第二節研究對象及場所 20 第三節研究工具 21 第四節資料收集方法 23 第五節資料處理與分析 26 第六節研究倫理 28 第四章資料分析與結果 29 第一節研究對象之基本屬性與臨床屬性 29 第二節重症病人角膜磨損發生率 31 第三節角膜磨損相關危險因子分析 32 第四節重症病人角膜磨損邏輯斯迴歸分析 34 第五節角膜磨損發生時間點的存活分析 35 第五章討論 38 第一節眼角膜磨損發生率 38 第二節重症病人角膜磨損危險因子 40 第六章結論與建議 44 第一節結論 44 第二節研究限制與建議 45 附錄 75 表目錄 表3.5.1 研究資料之統計分析方式 27 表1.4.1 GCS（Glasgow Coma Scale）：葛氏昏迷指數 54 表1.4.2 鎮靜程度評估量表(Richmond Agitation-Sedation Scale) 54 表2.2.1 重症病人角膜磨損發生率及危險因子 55 表2.2.2 比較提供重症病人不同角膜護理的角膜磨損發生率 56 表3.4.1 敏感性及特異性檢驗 58 表4.1.1 研究資料之統計分析方式 59 表4.1.2 個案使用藥物的描述統計表 61 表4.2.1 角膜嚴重程度及住院狀況變項統計表 62 表4.3.1 基本資料與角膜磨損的關係 63 表4.3.2 意識程度、眼瞼閉合能力與角膜磨損的關係 64 表4.4.1 影響角膜磨損因素之邏輯斯迴歸分析 66 表4.5.1 有無使用鎮定劑角膜磨損比率 66 表4.5.2 發生角膜磨損的個案有無使用鎮定劑及角膜磨損發生時間列表 67 表4.5.3 使用鎮定劑對角膜磨損時間表 68 表4.5.4 有無使用肌肉鬆弛劑角膜磨損比率 68 表4.5.5 發生角膜磨損的個案有無使用肌肉鬆弛劑及角膜磨損發生時間列表 69 表4.5.6 使用肌肉鬆弛劑對角膜磨損時間表 70 表4.5.7 使用鎮定劑角膜磨損發生時間列表 71 表4.5.8 使用肌肉鬆弛劑角膜磨損發生時間列表 71 圖目錄 圖3.4.1 收案流程圖 25 圖2.4.2 美國國家眼睛協會角膜分級系統 72 圖4.5.1 使用鎮定劑對角膜磨損發生曲線 73 圖4.5.2 使用肌肉鬆弛劑對角膜磨損發生曲線 73 圖4.5.3 鎮定劑對角膜磨損發生曲線 74 圖4.5.4 肌肉鬆弛劑對角膜磨損發生曲線 74 | |
| dc.language.iso | zh-TW | |
| dc.subject | 重症護理 | zh_TW |
| dc.subject | 眼 | zh_TW |
| dc.subject | 重症病人 | zh_TW |
| dc.subject | 角膜磨損 | zh_TW |
| dc.subject | 加護病房 | zh_TW |
| dc.subject | intensive care unit | en |
| dc.subject | eye | en |
| dc.subject | corneal abrasion | en |
| dc.subject | critical care | en |
| dc.title | 重症病人角膜磨損發生率與相關因子 | zh_TW |
| dc.title | The incidence and risk factors of corneal abrasion in critically ill patients | en |
| dc.type | Thesis | |
| dc.date.schoolyear | 102-2 | |
| dc.description.degree | 碩士 | |
| dc.contributor.oralexamcommittee | 王一中(I-Jong Wang),鄭之勛(Jih-Shuin Jerng) | |
| dc.subject.keyword | 眼,重症病人,角膜磨損,加護病房,重症護理, | zh_TW |
| dc.subject.keyword | eye,corneal abrasion,intensive care unit,critical care, | en |
| dc.relation.page | 76 | |
| dc.rights.note | 有償授權 | |
| dc.date.accepted | 2014-08-19 | |
| 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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