噪音對心臟手術後加護單位病人身心影響

Abstract

控制醫院的噪音音量是重要的，因為安靜的環境對於病人治療及休養是必要的。隨著加護單位醫療設備不斷地增加，造成高噪音的環境，常超過政府建議的標準，並對病人身心健康造成影響。國內外缺乏噪音對心臟手術後加護單位病人身心影響相關研究。本研究目的在探討噪音對心臟手術後加護單位病人身心影響。研究採橫斷式描述性及相關性研究設計，以立意取樣收集某台北某醫學中心之心臟外科加護單位病人為研究對象 ，於病人入住加護單位，從麻醉清醒2小時後開始收集噪音音量，及拔除氣管內管兩小時後收集生理參數包括心跳次數、動脈收縮壓、動脈舒張壓及平均動脈血壓，以瞭解加護單位噪音之時間分佈及噪音對心臟手術後加護單位病人生理反應影響，並以加護單位噪音主觀感受問卷來評估病人自覺加護單位音量、對加護單位噪音心理影響程度及主觀生理影響程度，及探討心臟手術後加護單位病人自覺加護單位音量及對噪音心理及主觀生理反應影響因素。 研究結果發現，病人感受加護單位噪音來源影響前四名為生理監視器及其警告聲、醫護人員的談話聲、移動醫療儀器輪子所發出的聲音和呼吸器及其警告聲。加護單位噪音平均音量介於59.0-60.8dB（A）之間，噪音最大音量平均介於77.3-81.3dB（A）之間，噪音最大音量尖峰值大於93dB（A）甚至達到113dB（A），病人自覺加護單位音量，大部份病人覺得不吵或有點吵。病人對加護單位噪音心理影響前三名為厭煩、驚嚇、及焦慮。病人對加護單位噪音主觀生理影響前三名為失眠、心跳增快、及易感疲倦；加護單位噪音與客觀生理反應呈顯著相關。此外心臟手術後加護單位病人自覺加護單位音量及對噪音心理及主觀生理反應影響因素，噪音敏感度與病人自覺加護單位音量、心理層面之厭煩、容易生氣、焦慮、緊張及主觀生理層面之失眠、心跳增快呈顯著相關，婚姻狀況與主觀生理層面之失眠呈顯著相關；而加護單位噪音與病人自覺加護單位音量、心理影響程度及主觀生理影響程度則無顯著相關。 本研究結果可提昇臨床護理人員對加護單位噪音的重視，建立噪音控制標準，發展噪音改善計畫，以作為臨床照護參考依據，進而消除或減低噪音源，避免過高的噪音環境引起病人身心不良影響，目標為提昇照護品質，創造真正具有治療價值的環境。

關鍵字：噪音、加護單位、身心影響

The control of noise level is important in hospitals because quietness is essential to rest and treatment of patients，but the growing numbers of medical devices in intensive care units (ICUs) create excessive amount of noise. It frequently exceeds the recommended level and has detrimental psychological and physiological effects. Up to now, there are few studies on the influence of noise to cardiac-surgical patients’ physiology and psychology in ICUs. This cross-sectional, descriptive, and prospective study is to investigate the influence of noise on the physiological and psychological aspects of cardiac-surgical patients in ICUs. Patients, who were admitted to a cardiac surgical ICU in a medical center were prospectively collected for this study. After their admission to ICUs for postoperative care , we measured the surrounding noise level since 2 hours after awakening from anesthesia. The patient’s physiologic parameters including heart rate(HR),systolic arterial blood pressure(SABP),diastolic arterial blood pressure(DABP), and mean arterial blood pressure(MABP) were recorded since 2 hours after extubation.. This study investigated the noise level- time- distribution in ICUs and its physiological effects on cardiac-surgical patients in ICUs. We also developed a questionnaire to evaluate the patients’ subjective perception on the noise level,psychological effects and subjective physiological effects. We also investigate the relationship between noise and the patients’ subjective perception on the noise level,psychological effects and subjective physiological effects in cardiac-surgical patients in ICUs. Our study showed that the patients’ complained most often about the noises from the monitor alarms, loud conversation among staff, transport of medical devices and ventilator alarms. The noise equivalent continuous sound pressure levels(Leq) is between 59.0-60.8dB(A),the maximal sound pressure levels (Lmax)is between 77.3-81.3dB(A),and the peak sound pressure levels (Lpeak) is above 93dB(A), sometimes reaching 113dB(A), Regarding the patients’ subjective perception on the noise level, most patients felt that the noise level was not loud or a little loud. In addition, the top three psychological effects of noise on cardiac-surgical patients in ICUs are annoyance, startle and anxiety. The top three subjective physiological effects of noise on cardiac-surgical patients in ICUs are insomnia, tachycardia and easy fatigue. Our data also revealed significantly correlation between noise in ICU and objective physiological response(HR,SABP,DABP,MABP). There were significant correlation between noise sensitivity and patient patients’ subjective perception on the noise level, psychological effects of noise including annoyance, anger, anxiety and nervousness, and subjective physiological effects including insomnia, tachycardia. There was significant correlations between marriage and insomnia in objective Physiological response .However, there is no significant correlation among noise itself in ICU and the patients’ subjective perception on the noise level, psychological effects and subjective physiological effect. Our study can increase the awareness of nursing staff to noises in ICU and help developing noise reduction program by setting up noise control standard for daily clinical care, and eliminating or reducing the noise sources. It is our goal to improve quality of care, prevent adverse effects from excessive noise, and create a truly therapeutic environment.

Keyword：Noise, Intensive care units, Physiological and Psychological effects