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標題: | 熱攝影用於社區失能老人之壓力性損傷傷口評估 Thermography assessment for community-acquired pressure injury among the disable elderly |
作者: | Chun-Wei Chang 張君蔚 |
指導教授: | 張念慈 |
關鍵字: | 熱攝影,失能老人,壓力性傷口,壓瘡,癒合, Thermograpy,disable elderly,pressure injury,pressure ulcer,healing, |
出版年 : | 2019 |
學位: | 碩士 |
摘要: | 台灣老年人口極速成長,慢性病與功能障礙者的需求遽增,其中又以75歲失能老人及85歲以上超高齡長者較一般65歲以上老人有更高的壓瘡風險。壓瘡除了是複雜性傷口,癒合過程耗時是長者及其家屬的主要負擔。在醫學中心急診,每天都有許多失能老人從醫院以外帶有現存壓瘡傷口入院,而不是在醫院內才發生壓瘡。院外帶入之現存壓瘡照護和快速篩檢對急診來說相當重要。本研究目的有四:
1. 探討急診之社區失能老人存有壓瘡者之人口學及疾病特徵。 2. 探討壓瘡各分期與老人傷口癒合之生理因子相關性。 3. 探討壓瘡傷口嚴重度與主要照護者之相關性。 4. 以温度和生理因子建立評估壓瘡傷口癒合預後之評估指標。 研究方法:本研究採前瞻性追蹤研究設計,以醫學中心急診入院的社區失能者為研究對象,蒐集壓瘡傷口癒合相關因子,並使用溫度熱顯像儀評估病人之壓瘡傷口,蒐集急診入院的社區失能老人之人口學特性、疾病學特性、在社區壓瘡之傷口特性、不同嚴重度傷口溫度梯度特性、照護者資料,以及入院時生理相關資料之比較性研究,以線性迴歸係數了解各分期之影響權重、使用廣義估計方程式(GEE)分析影響壓瘡傷口癒合之因子,探討壓瘡嚴重度之指標。 研究結果:本研究分為壓瘡嚴重度相關因子、壓瘡癒合相關因子及溫度成像儀評估結果三個部分,意識狀況、肌肉骨骼疾病、腦血管疾病、血紅素、ADL日常活動能力及水腫與否皆會從不同面向影響壓瘡傷口嚴重社區失能老人年齡、意識狀況、活動能力、照護者的教育程度、年齡及照顧壓力負荷、老人營養狀態、肌肉骨骼疾病、腦血管疾病、高血壓、多重慢病、白蛋白及白血球皆會影響壓瘡傷口癒合。而溫度熱顯像方面,缺血性壓瘡之低溫組嚴重度較高溫組高且預後較差。 結論:壓瘡的促進癒合因子會從不同面向去影響壓瘡傷口嚴重度及其預後,在臨床上使用不同的壓瘡評估方式可能會有不同結論產生。壓瘡傷口本身只是全面性問題之一隅,而科技輔助之多層面評估是未來必要的評估步驟及研究方向。 Along with the population of Taiwan is aging at an incredibly rapid rate, the demand for medical care of chronic disease and disability increased. According to National Long-term care survey, disable rate of 75-year-old population triple than 65-year-old population, and over a half in ages of >85-year-old population. Pressure injury is complicated wound and chronic wound. Time consuming of wound healing is the main burden of patient and their family. Pressure injury in community population can be detected in emergency department usually. Therefore, in emergency department assessment and care of pressure injury already developed in community is as important as prevention. There are four Purpose of our research: 1. Explore the demography and epidemiology of disable elderly in emergency department with pressure injury developed in community;2. Explore the correlation of severity of pressure injury and physiological factors. 3. Explore the correlation of severity of pressure injury and family caregiver factors. 4. Explore the assessment indicators of severity of pressure injury and healing. Methods: An observation research with prospective design was adopted. Using self-administered questionnaire to collect data including demographic characteristics, epidemiology characteristics, family car giver characteristics and lab data;Using thermography, PUSH and PSST scale to assess initial, seven days and a month later presentation of pressure injury noticed in emergency department. ANOVA was conducted to explore the factors associated to the grade of pressure injury;linear regression was conducted to explore the factors associate to the severity of pressure injury and GEE was conducted to explore associated factors of wound healing. Result: Consciousness, age, past history of disease, hemoglobin and obesity affect the severity of pressure injury in different assessment dimension; consciousness, past history of disease, lab data, ADL, IADL, CDR, age, care giver and obesity influence the healing of pressure injury in different assessment dimension; pressure injury exhibited low temperature on thermographic assessment, all of which were associated with bad outcome compare with equal and high temperature. Conclusion: Indicators of severity and healing of pressure injury can be different due to different assessment tool, and make different conclusion. Pressure injury present no only wound but also whole picture of patient condition. Therefore, the multi-dimension assessment with technology-assisted is the necessary assessment steps and research directions in the future. |
URI: | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/21723 |
DOI: | 10.6342/NTU201900747 |
全文授權: | 未授權 |
顯示於系所單位: | 護理學系所 |
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