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完整後設資料紀錄
DC 欄位 | 值 | 語言 |
---|---|---|
dc.contributor.advisor | 黃貴薰(Guey-Shiun Huang) | |
dc.contributor.author | Yu-Shang Chen | en |
dc.contributor.author | 陳右尚 | zh_TW |
dc.date.accessioned | 2021-06-17T06:16:59Z | - |
dc.date.available | 2021-08-30 | |
dc.date.copyright | 2018-08-30 | |
dc.date.issued | 2018 | |
dc.date.submitted | 2018-08-21 | |
dc.identifier.citation | 中文參考資料
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International Psychogeriatric, 19, 197-214. DOI: 10.1017/S104161020600425X Brunner, L. C., Eshilian-Oates, L., & Kuo, T. Y.(2003). Hip fractures in adults.American Family Physician, 67(3), 537-542. Christie, J., Macmillan, M., Currie, C., & Matthews-Smith, G. (2014). Improving the experience of hip fracture care: A multidisciplinary collaborative approach to implementing evidence-based, person-centered practice. International Journal of Orthopaedic and Trauma Nursing, 19(1), 24-35. DOI: 10.1016/j.ijotn.2014.03.003. Dasgupta, M., & Dumbrell, A.C. (2006). Preoperative risk assessment for delirium after non-cardiac surgery: A systematic review. Journal of the America Geriatric Society, 54, 1578–1589. DOI: 10.1111/j.1532-5415.2006.00893.x Ely, E. W., & Gautam, S. (2004). The impact of delirium in the intensive care unit on length of stay. Intensive Care Medicine, 27(1), 1892-1900. DOI: 10.1007/s00134-001-1132-2 Flinn, D. R., Diehl, K. M., Seyfried, L. S., & Malani, P. N.(2009). 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G., Wakefield, B., Kundrat, M., Mentes, J., Tripp-Reimer, T., Culp, K., Mobily, P., Akins, J. & Onega, L. L. (2000). Acute confusion assessment instru-ments: Clinical versus research usability. Applied Nursing Research, 13(1), 37-45. Segatore, M., & Adams, D. (2001). Managing delirium and agitation in elderly hospitalized orthopedic patients: Part 1 –Theoretical aspects. Orthopaedic Nursing, 20(1), 31-45. DOI: 10.1097/TME.0000000000000066 Shiga, T., Wajima, Z., & Ohe, Y. (2008). Is operative delay associated with increased mortality of hip fracture patients? Systematic review, meta-analysis, and meta- regression. Canadian Journal of Anesthesiology, 55(3), 146-154. DOI: 10.1007/BF03016088 Tsang, L. F. (2014). Nurses’ prediction prevention and management on post-operative delirium in geriatric patients with hip fracture: The development of a protocol to guide care. International Journal of Orthopaedic and Trauma Nursing, 18, 23-34. 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dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/71966 | - |
dc.description.abstract | 【背景】老年人髖部骨折手術後譫妄症發生率高,危害了身體日常生活功能引發併發症,延長住院天數,增加照顧者的負擔。引發譫妄症的原因為多重因素,在髖部骨折族群手術期間的影響因子,各研究所呈現的結果不同。
【目的】探討引發高齡髖部骨折病人術後譫妄症發生情形,及其風險因子之關聯性。 【研究方法】本研究為前瞻性、描述性、相關性之觀察研究,自2017年4月1日至12月31日依方便取樣方式選取高齡髖部骨折病人,以混亂評估法(confusion assessment method, CAM)為工具,調查高齡髖部骨折術後譫妄症發生率,並收集引發術後譫妄症之風險因子-人口學特性、病人原有因子、手術相關因子,以分析驗證每個風險因子之勝算比Odds Ratio(OR)。 【研究結果】篩選102位病人,排除術前發生譫妄症9位,共93位研究對象納入分析;術後譫妄症發生率為54.8%,平均年齡84.5歲,譫妄症持續時間24~72小時佔84.4%,發生譫妄症組術後有延後下床活動,及每日離床活動時間較短的情形。有發生術後譫妄症男性佔較多,平均年齡較大;風險因子單變項分析顯示,年齡越大者越傾向發生術後譫妄症,有宗教信仰者、Mini-Mental State Examination (MMSE)分數越高者、入院時血紅素與血比容檢驗值越高者較不傾向發生術後譫妄症。多變項邏輯式迴歸模式分析發現,MMSE分數越高者越不傾向發生術後譫妄症,MMSE每增加1分減少38 %發生譫妄症的風險 (OR=0.62) 【結論】高齡髖部骨折病人術後譫妄症發生率高,認知功能缺損為顯著的風險因子。醫療團隊應在病人術前執行風險因子評估,術後常規評估混亂評估法CAM,並及早給予介入性措施,以降低術後譫妄症及其合併症之發生。 | zh_TW |
dc.description.abstract | Background: Orthopedic surgery is the best treatment recommended for hip fractures, however, the procedure often induce postoperative delirium. Any age group is susceptible to postoperative delirium, but high prevalence rates of post-operative delirium have been found in geriatric patients with hip fracture.
Purpose: There is a lack of research focused on the geriatric population with hip fracture. The purpose of this study was to establish the incidence rate of post-operative delirium among elderly patients and to identify risk factors. Methods: A prospective observational design with repeated measures was used. Subjects older than 65 years who had suffer from hip fracture due to fall will be recruited when admitted in orthopedic ward. The Confusion Assessment Method will be the study tool to assess twice a day to identify subjects experiencing delirium by research team. The demographic data, history of illness, operation process, and laboratory data of the patients were recorded. The demographic data of participants were analyzed to obtain the logistic regression to identify factors associated with the odds ratio. Result: There were One hundred-and-two participants had been screened, and nine of whom was excluded due to the pre-existing delirium. Ninety-three participants with hip fracture were included. The incidence rate of delirium was 54.8%. The average age was 84.5. When postoperative delirium occurred, time to ambulation after surgery was delayed and the average ambulation time per day was decreased. The risk factors were analyzed by logistic regression. Univariate regression suggested age, religion, MMSE (Mini-Mental State Examination), hemoglobin, and hematocrit may be associated to postoperative delirium. Multivariate regression suggested MMSE was a significant risk factor of postoperative delirium in hip fracture. Conclusion: Postoperative delirium has significant impacts on the recovery and long term well-being of elderly patients. Significant predictive risk factors can be parsed out to help practitioners identify patients who are more susceptible to postoperative delirium before they receiving surgery. Recognizing patients who are more likely to develop delirium can also help practitioners develop individualized management to extend postoperative monitoring as needed and mitigate surgical risk factors. | en |
dc.description.provenance | Made available in DSpace on 2021-06-17T06:16:59Z (GMT). No. of bitstreams: 1 ntu-107-R02426015-1.pdf: 1786976 bytes, checksum: e0526a6db19f2b4d60a1e6a71fbdee98 (MD5) Previous issue date: 2018 | en |
dc.description.tableofcontents | 誌謝i
中文摘要ii 英文摘要iii 圖目錄v 表目錄vi 第一章 緒論1 第一節 研究緣起1 第二節 研究目的3 第三節 名詞界定4 第二章 文獻探討5 第一節 高齡髖部骨折之簡介5 第二節 術後譫妄症9 第三節 高齡術後發生譫妄症之危險因子11 第四節 譫妄症之評估工具13 第五節 高齡髖部骨折術後瞻妄症的預防與處置16 第三章 研究方法18 第一節 研究設計18 第二節 研究架構18 第三節 研究對象19 第四節 研究工具20 第五節 研究資料收集流程23 第六節 資料分析24 第七節 研究倫理考量25 第四章 研究結果26 第一節 研究對象基本屬性之概況26 第二節 研究對象術後譫妄症之發生情形30 第三節 影響研究對象發生術後譫妄症之風險因子32 第四節 各風險因子對於研究對象發生術後譫妄症的相關性38 第五章 討論42 第一節 研究對象基本屬性概況之評析42 第二節 研究對象術後譫妄症發生情形與臨床處置之評析44 第三節 影響研究對象發生術後譫妄症風險因子之探討47 第四節 各風險因子影響研究對象發生術後譫妄症相關性之探討50 第六章 結論與建議52 第一節 結論52 第二節 研究限制與建議56 第三節 臨床應用58 參考資料60 中文參考資料60 英文參考資料61 附錄66 附錄一 高齡髖部骨折術後譫妄症危險因子評估表66 附錄二 臨床試驗/研究計畫 受試者同意書71 附錄三 IRB 核准函/ 持續審查核准函77 | |
dc.language.iso | zh-TW | |
dc.title | 高齡髖部骨折病人術後譫妄症危險因子之探討 | zh_TW |
dc.title | Risk Factors of Postoperative Delirium in Elderly Patients with Hip Fracture | en |
dc.type | Thesis | |
dc.date.schoolyear | 106-2 | |
dc.description.degree | 碩士 | |
dc.contributor.oralexamcommittee | 羅美芳(Meei-Fang Lou),邱方遙(Fang-Yao Chiu) | |
dc.subject.keyword | 高齡病人,髖部骨折,術後譫妄症,風險因子, | zh_TW |
dc.subject.keyword | elderly patients,hip fracture,post-operative delirium,risk factors, | en |
dc.relation.page | 80 | |
dc.identifier.doi | 10.6342/NTU201803576 | |
dc.rights.note | 有償授權 | |
dc.date.accepted | 2018-08-22 | |
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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