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完整後設資料紀錄
DC 欄位 | 值 | 語言 |
---|---|---|
dc.contributor.advisor | 陳佳慧 | |
dc.contributor.author | Yu-Huei Yen | en |
dc.contributor.author | 顏于惠 | zh_TW |
dc.date.accessioned | 2021-06-17T07:04:05Z | - |
dc.date.available | 2024-08-27 | |
dc.date.copyright | 2019-08-27 | |
dc.date.issued | 2019 | |
dc.date.submitted | 2019-07-29 | |
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dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/72706 | - |
dc.description.abstract | 研究背景與目的:重症系統性乏力的診斷必須排除入加護病房前的系統性乏力,本研究旨於發展病人自覺肌力問卷用以排除入住加護病房前的系統性乏力並初探內科加護病房患者轉出加護病房時的重症系統性乏力盛行率。
研究方法:病人自覺肌力問卷的發展分兩階段進行。第一階段,依據重症系統性乏力黃金診斷指標Medical Research Council scale, MRC擬定3-5分肌力強度的問卷題目,並以李克特量表完成專家內容效度。第二階段,採前瞻性世代研究,收取入加護病房超過24小時之成年病患,排除入院前長期臥床者或是入院前長期意識不清或昏迷者,於出加護病房時完成MRC之評估,並於出加護病房後一個月再完成自覺肌力問卷。分析比較病人自覺肌力問卷和黃金指標工具MRC的結果差異,包括皮爾森相關係數、Cohen’s Kappa係數、敏感性、特異度、陽性預測值及陰性預測值等篩檢指標。 研究結果:第一階段發展之病人自覺肌力問卷共18題,題目是對應至MRC六組左右對稱受測部位3-5分肌力強度的肌力動作,總分60分,具良好的專家內容效度。第二階段研究自2018年8月至2019年2月共納入31名內科加護病房患者,評估其轉出加護病房時重症系統性乏力的有無並追蹤其至轉出後一個月。轉出加護病房時,MRC評估為<48分共有13名,重症系統性乏力盛行率為42%。比較轉出加護病房一個月後所填的自覺轉出時肌力得分和一個月前黃金診斷指標MRC,結果顯示二者得分的皮爾森相關係數r=0.64,結果判定的Kappa一致性係數κ=0.33;以自覺肌力問卷篩檢重症系統性乏力的敏感性為100%,但特異度僅有38%,換算陽性預測值為50%,陰性預測值100%。進一步檢視偽陽性病人之特性,若調整加入Mini-mental Status Examination, MMSE得分<20分做為搭配自覺肌力問卷<48分來篩檢重症系統性乏力的新標準,將獲得敏感性91%,特異度89%,陽性預測值83%,陰性預測值94%。 結論:初步發展的自覺肌力問卷在篩檢重症性統性乏力具有高敏感性,可排除系統性乏力的病人。惟特異度過低,顯示個案或許低估自己在轉出加護病房的肌力表現,又或是問卷肌力表現設定過高,未來研究可進一步提升問卷題目鑑別度亦或可考慮結合MMSE<20分來排除入住加護病房前的重症系統性乏力,以降低偽陽性發生。 | zh_TW |
dc.description.abstract | Background & Objectives: Manual Medical Research Council (MRC) Scale for Muscle Strength is well-established to screen for intensive care unit - acquired weakness (ICUAW). It is fundamental to rule out pre-ICU weakness in order to diagnose ICUAW in the ICU settings. The aims of this study were to develop a self-reported muscle strength Questionnaire-MRC (Q-MRC) to rule out patients’ pre-ICU weakness and to explore the prevalence of ICUAW using the MRC scale.
Method: The development of Q-MRC consists of two phases. At phase one, items were drafted to correspond with the manual MRC scale in the muscle strength levels of 3 to 5. A 7-expert panel rated each item using a 4-point Likert scale. At phase two, a prospective cohort study was conducted at a university hospital’s 6 medical ICUs. Excluding bedridden and patients who were unable to follow command, 31 participants aged≧20 years and stayed ICU over 24 hours were enrolled. The manual MRC was completed at ICU discharge by trained nurses and Q-MRC was completed one-month after ICU discharge using patient interviews. Results of manual MRC and Q-MRC were compared using Pearson correlation, Cohen’s Kappa statistics, sensitivity, specificity, and positive/negative predictive values. Results: The 18-item Q-MRC was developed with good content validity. Items were properly matched to muscle strength level 3-5 among 6 pairs of MRC testing groups. From August 2018 to February 2019, with 31 participants completed manual MRC at ICU discharge. 13 (42%) scored <48 and found to have ICUAW. Comparing Q-MRC with MRC, the Pearson correlation of the scores was 0.64 and Cohen’s kappa of two tools was 0.33 indicating fair agreement. The sensitivity of Q-MRC was 100% and 38% in specificity, 50% in positive predictive value (PPV), and 100% in negative predictive value (NPV). Further analyses revealed that adding the Mini-mental status examination (MMSE) <20 as a must-have criterion enhances the Q-MRC performance as the MMSE<20 plus Q-MRC<48 resulting in 91% in sensitivity, 89% in specificity, 83% in PPV, and 94% in NPV. Conclusion: The self-report Q-MRC is very sensitive to rule out ICUAW, but the false-positive requiring further work. Whether ICU patients tended to under-report their muscle strengths or item scoring of Q-MRC was too strict requiring further study. Nevertheless, adding low MMSE status as an additional criterion enhances the performance of Q-MRC by reducing false-positive of cases. | en |
dc.description.provenance | Made available in DSpace on 2021-06-17T07:04:05Z (GMT). No. of bitstreams: 1 ntu-108-R04426016-1.pdf: 1793897 bytes, checksum: 6c77c7f94b8a7ea840c1c04d89e8c865 (MD5) Previous issue date: 2019 | en |
dc.description.tableofcontents | 目錄
口試委員會審定書 i 致謝 ii 中文摘要 iv 英文摘要 vi 圖目錄 x 表目錄 xi 第一章 緒論 1 第一節 研究動機與重要性 1 第二節 研究問題 3 第三節 研究目的 4 第二章 文獻查證 5 第一節 重症系統性乏力的臨床表現與致病機轉 5 第二節 重症系統性乏力的診斷方式 7 第三節 MRC分級系統的發展與臨床應用 9 第四節 MRC上肢指定動作使用到的肌肉和其運動 12 第五節 MRC下肢指定動作使用到的肌肉和其運動 13 第三章 研究方法 15 第一節 研究假設 15 第二節 研究架構 16 第三節 名詞解釋及操作型定義 17 第四節 研究設計 18 第五節 研究場所及對象 19 第六節 研究工具 21 第七節 病人自覺肌力問卷的建構 22 第八節 資料處理及分析 33 第九節 研究倫理考量 34 第四章 研究結果 35 第一節 研究對象之基本屬性 37 第二節 有重症系統性乏力組與無重症系統性乏力組之臨床變項比較分析 41 第三節 有重症系統性乏力組與無重症系統性乏力組之MRC分數分析 44 第四節 MRC測試分數與「病人自覺肌力問卷」回顧分數之線性迴歸分析 47 第五節 MRC測試結果與「病人自覺肌力問卷」回顧結果一致性分析 49 第五章 討論 51 第一節 加護病房病人轉出加護病房時發生重症系統性乏力的情形 51 第二節 MRC肌力測試與病人自覺肌力問卷之間測量結果的比較 54 第六章 結論 59 第一節 結論 59 第二節 研究限制與建議 59 參考文獻 61 附件一、入加護病房評估資料 67 附件二、轉出加護病房評估資料 69 | |
dc.language.iso | zh-TW | |
dc.title | 自覺肌力問卷的發展與重症系統性乏力的觀察研究 | zh_TW |
dc.title | Developing a self-reported muscle strength questionnaire and observing ICU acquired weakness at ICU discharge. | en |
dc.type | Thesis | |
dc.date.schoolyear | 107-2 | |
dc.description.degree | 碩士 | |
dc.contributor.oralexamcommittee | 王亭貴,古世基,王興國 | |
dc.subject.keyword | 自覺肌力問卷,加護病房,加護病房乏力,肌肉乏力,重症病人肌力,重症系統性乏力, | zh_TW |
dc.subject.keyword | Self-reported questionnaire,Questionnaire-MRC,Intensive Care Unit acquired weakness,Medical Research Council scale,ICU discharge, | en |
dc.relation.page | 71 | |
dc.identifier.doi | 10.6342/NTU201902027 | |
dc.rights.note | 有償授權 | |
dc.date.accepted | 2019-07-29 | |
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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