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http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/90345完整後設資料紀錄
| DC 欄位 | 值 | 語言 |
|---|---|---|
| dc.contributor.advisor | 唐嘉君 | zh_TW |
| dc.contributor.advisor | Chia-Chun Tang | en |
| dc.contributor.author | 黃怡婷 | zh_TW |
| dc.contributor.author | Yi-Ting Huang | en |
| dc.date.accessioned | 2023-09-27T16:06:17Z | - |
| dc.date.available | 2023-11-09 | - |
| dc.date.copyright | 2023-09-27 | - |
| dc.date.issued | 2023 | - |
| dc.date.submitted | 2023-08-07 | - |
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Circulation, 130(15), 1236-1244. https://doi.org/10.1161/circulationaha.114.010942 Yu, Y. J., Weng, W. C., Su, F. C., Peng, T. I., Chien, Y. Y., Wu, C. L., Lee, K. Y., Wei, Y. C., Lin, S. W., Zhu, J. X., & Huang, W. Y. (2016). Association between pneumonia in acute stroke stage and 3-year mortality in patients with acute first-ever ischemic stroke. J Clin Neurosci, 33, 124-128. https://doi.org/10.1016/j.jocn.2016.02.039 Zhang, Y. W., Dou, Z. L., Zhao, F., Xie, C. Q., Shi, J., Yang, C., Wan, G. F., Wen, H. M., Chen, P. R., & Tang, Z. M. (2022). Neuromuscular electrical stimulation improves swallowing initiation in patients with post-stroke dysphagia. Front Neurosci, 16, 1011824. https://doi.org/10.3389/fnins.2022.1011824 Zhu, H. W., McGrath, C., McMillan, A. S., & Li, L. S. (2008). Can caregivers be used in assessing oral health-related quality of life among patients hospitalized for acute medical conditions? Community Dent Oral Epidemiol, 36(1), 27-33. https://doi.org/10.1111/j.1600-0528.2006.00370.x 黃婷, 張瑛瑛, 廖若伶, 黃春佈, 廖月鳳, & 施美伶. (2018). 提升腦中風病人執行吞嚥訓練自我練習完整率. 榮總護理, 35(3), 314-321. https://doi.org/10.6142/VGHN.201809_35(3).0010 衛生福利部. (2019年6月30日). 108年底機構執業醫事人員數及每萬人口醫事人員數 https://dep.mohw.gov.tw/DOS/cp-1735-3245-113.html 衛生福利部. (2021年4月1日). 高齡者及特殊需求者口腔機能促進 https://dep.mohw.gov.tw/domhaoh/cp-486-57213-107.html 衛生福利部. (2023年6月12日). 111年國人死因統計結果. https://www.mohw.gov.tw/cp-16-74869-1.html | - |
| dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/90345 | - |
| dc.description.abstract | 背景: 腦中風已成全球第二大死因疾病，也是導致成人死亡與失能的主要原因。在台灣腦中風相關性肺炎發生率約為一成，可能導因包括吞嚥困難及誤吸。由於吞嚥困難影響多達一半的急性中風患者，早期發現和積極介入，對於預防中風後吞嚥困難所引發的肺部併發症，非常重要。然而目前對於中風吞嚥困難及預防肺炎發生的處置，尤其是早期介入，仍無理想策略。
目的:利用合併「經皮神經肌肉電刺激治療」及「口腔護理」措施介入，改善中風病人口腔衛生與吞嚥功能，進而降低腦中風相關性肺炎發生。 研究方式:本研究為優越性試驗 (superiority trial)，採平行設計 (Parallel design)研究法，將研究對象隨機分派為實驗組A、實驗組B，或控制組。實驗組A接受口腔護理，實驗組B接受口腔護理合併經皮神經肌肉電刺激治療，控制組則接受常規照護。三組分別於腦中風發作後48小時內進行基準值前測評估，腦中風發生第四日及第八日進行資料收集與後測評估。評估內容包含美國國立衛生研究院中風量表、格拉斯哥昏迷指數、修訂後的口腔評估指南、Gugging 吞嚥篩檢及EAT-10問卷，並收集住院期間的臨床評估指標及是否併發肺炎。基準資料及最終肺炎是否發生，使用One-way ANOVA + Scheffe事後檢定及卡方檢定以確認三組病人之差異。運用Generalized Estimating Equation (GEE)檢測個時間點之三組變化差異。 結果:共有35個病人加入研究，其中實驗組A、B及控制組各有13, 10, 12人，中輟率為2.9%。以男性占多數(51.4%)，平均年紀為68.3，中風後肺炎發生率為33.3%。本研究發現早期的口腔護理介入對於改善腦中風急性期患者的口腔和吞嚥狀況具有顯著的成效；而當合併使用NMES電刺激訓練時，不僅比單純口腔護理可顯著改善口腔狀況，亦能顯著增進吞嚥功能之功能回復，同時能夠進一步減少腦中風相關性肺炎的發生率。此成果可應用於提升臨床照護品質及建議未來研究方向，例如提供醫護團隊預防腦中風相關性肺炎策略，以把握早期預防措施介入之時機。 | zh_TW |
| dc.description.abstract | Background: Stroke has become the second leading cause of death worldwide and the leading cause of adult death and disability. The incidence of stroke- associated pneumonia in Taiwan is about 10%, which may be due to the high incidence of dysphagia or aspiration. Dysphagia affects up to half of acute stroke patients, and early detection and active intervention are important to prevent pulmonary complications after stroke. However, little strategies are currently available for managing and improving stroke-associated dysphagia early and preventing pneumonia.
Purpose: The purpose of this study was to combine "transcutaneous neuromuscular electrical stimulation therapy" and "oral care" to improve the oral hygiene and swallowing function of stroke patients, and thereby reducing the incidence of stroke-associated pneumonia. Research method: This study was a superiority trial with parallel design. The study participants were randomly assigned to the two experimental groups or the control group. The experimental group A received oral care and experimental group B received oral care combined with transcutaneous neuromuscular electrical stimulation. The control group received routine care. Data collection occurred at three time points: within 48 hours of stroke onset, on the fourth day, and on the eighth day of the stroke. Data was evaluated according to National Institutes of Health Stroke Scale and Glasgow Coma index, Revised oral assessment guide, Gugging swallowing screening and EAT-10 questionnaire. One-way ANOVA with Scheffe post hoc test and Chi-square test were used to determine the differences between groups at baseline and the occurrence of stroke-associated pneumonia. Generalized Estimating Equation (GEE) was employed to detect group differences regarding score changes along the time. Results: A total of 35 participants were included in the analysis with 13 in experimental group A, 10 in experimental group B, and 12 in the controlled group. The majority is male (51.4 %) and the mean age was 68.3. The dropout rate was 2.9%. The incidence of stroke-associated pneumonia was 33.3%. The results showed that early "oral care" intervention significantly improved the oral healthy and swallowing function of stroke patients in the acute stage. Comparing to control group and oral care only, combined intervention of oral care and "transcutaneous neuromuscular electrical stimulation" was significantly more effective in improving oral status and enhancing swallowing function. At the same time, both interventions can reduce the incidence of stroke-associated pneumonia. This result can be applied to improve the quality of clinical care in the acute stage post stroke. It also informs future research directions, including proposing new strategies and care model to prevent stroke-associated pneumonia. | en |
| dc.description.provenance | Submitted by admin ntu (admin@lib.ntu.edu.tw) on 2023-09-27T16:06:17Z No. of bitstreams: 0 | en |
| dc.description.provenance | Made available in DSpace on 2023-09-27T16:06:17Z (GMT). No. of bitstreams: 0 | en |
| dc.description.tableofcontents | 口試委員會審定書……………………………………………………………………..i
致謝…………………………………………………………………………………….ii 中文摘要………………………………………………………………………………iii 英文摘要………………………………………………………………………………iv 第一章 緒論……………………………………………………………………………9 第一節 研究背景與重要性…….……………...……………………………..9 第二節 研究問題與假設...……...…………………………………………..11 第二章 文獻探討……………………………………………………………………..12 第一節 腦中風相關性肺炎及其危險因子………………………………….12 第二節 腦中風後吞嚥困難………………………………………………….14 第三節 經皮神經肌肉電刺激治療吞嚥困難……………………………….16 第四節 口腔衛生預防腦中風相關性肺炎………………………………….18 第五節 口腔與吞嚥困難評估……………………………………………….20 第六節 研究架構…………………………………………………………….23 第三章 研究方法……………………………………………………………………..24 第一節 研究設計…………………….………………………………………24 第二節 研究對象與場所…………………………………………………….25 第三節 研究工具…………………………………………………………….26 第四節 資料收集流程……………………………………………………….27 第五節 介入措施…………………………………………………………….29 第六節 資料處理與分析…………………………………………………….31 第七節 研究倫理考量……………………………………………………….31 第四章 研究結果……………………………………………………………………..32 第一節 研究對象基本資料與前測之組間比較…………………………….33 第二節 研究對象中風嚴重程度之基準前測量 (T0) 與組間比較…………35 第三節 「口腔護理」及合併治療介入對於吞嚥功能影響……………….37 第四節 「口腔護理」及「NMES」介入對其SAP發生之差異………….43 第五章 討論……………………………………………………………………….…43 第一節 研究對象基本資料………………………………………………….44 第二節 中風嚴重程度及影響口腔及吞嚥功能…………………………….46 第三節 「口腔護理」及「NMES」介入對於吞嚥功能影響………...…...48 第四節 「口腔護理」及合併介入與SAP發生之關係……………...…….49 第六章 結論…………………………………………………………………………..50 參考文獻……………………………………………………………………………...51 附錄一………………………………………………………………………………...69 附錄二………………………………………………………………………………...77 | - |
| dc.language.iso | zh_TW | - |
| dc.subject | 經皮神經肌肉電刺激治療 | zh_TW |
| dc.subject | 急性腦梗塞 | zh_TW |
| dc.subject | 吞嚥困難 | zh_TW |
| dc.subject | 腦中風相關性肺炎 | zh_TW |
| dc.subject | 口腔護理 | zh_TW |
| dc.subject | stroke-associated pneumonia | en |
| dc.subject | dysphagia | en |
| dc.subject | acute cerebral infarction | en |
| dc.subject | oral care | en |
| dc.subject | transcutaneous neuromuscular electrical stimulation | en |
| dc.title | 經皮神經肌肉電刺激治療合併口腔護理介入對急性腦梗塞併吞嚥困難患者之成效 | zh_TW |
| dc.title | Application of transcutaneous neuromuscular electrical stimulation treatment combined with oral nursing intervention effects on patients with acute cerebral infarction with dysphagia | en |
| dc.type | Thesis | - |
| dc.date.schoolyear | 111-2 | - |
| dc.description.degree | 碩士 | - |
| dc.contributor.oralexamcommittee | 葉馨喬;鍾其祥 | zh_TW |
| dc.contributor.oralexamcommittee | Shin-Joe Yeh;Chi-Hsiang Chung | en |
| dc.subject.keyword | 急性腦梗塞,吞嚥困難,腦中風相關性肺炎,經皮神經肌肉電刺激治療,口腔護理, | zh_TW |
| dc.subject.keyword | acute cerebral infarction,dysphagia,stroke-associated pneumonia,transcutaneous neuromuscular electrical stimulation,oral care, | en |
| dc.relation.page | 80 | - |
| dc.identifier.doi | 10.6342/NTU202302537 | - |
| dc.rights.note | 同意授權(限校園內公開) | - |
| dc.date.accepted | 2023-08-08 | - |
| dc.contributor.author-college | 醫學院 | - |
| dc.contributor.author-dept | 護理學研究所 | - |
| dc.date.embargo-lift | 2028-08-07 | - |
| 顯示於系所單位： | 護理學系所 | |
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