2019-08-012024-05-16https://scholars.lib.ntu.edu.tw/handle/123456789/669452摘要：加護病房出院後第一年存活者有近一半無法獨立生活或重回工作崗位，生理活動功能下降非常常見。加護病房譫妄 (Intensive Care Unit Acquired Delirium, ICU-AD) 及重症系統性乏力 (Intensive Care Unit Acquired Weakness, ICU-AW)均為重要導因。本研究計畫首要目的有三: 一、探討加護病房存活病患第一年的生理活動功能恢復及時間趨勢；二、探討加護病房譫妄及重症系統性乏力的發生率；三、探討加護病房譫妄及重症系統性乏力的發生如何影響病患第一年的生理活動功能恢復及時間趨勢。計畫將分為三年進行，採前瞻、縱貫性觀察研究設計，用連續取樣 (consecutive sampling) 以臺大醫院六間內科加護病房成人病患為研究對象，在其加護病房期間及出加護病房的 1, 3, 6, 12月的六個時間點進行長期追蹤。進行方式為：所有簽署同意書的病患，研究護理師將於每日評估其是否發生加護病房譫妄，並於轉出加護病房時評估重症系統性乏力之有無；所有成功轉至普通病房並可配合追蹤者，團隊將於病患轉出加護病房的 1, 3, 6, 12月進行完整生理活動功能評估【六分鐘走路測試、手握力測試、呼吸肌肌力測試、MMSE認知功能、ADL/IADL日常生活活動能力評估】及全身身體肌肉質量【身體組成分析儀】檢測。依據檢力分析，預計收案158名病患。所得資料將以 SPSS 24版統計套裝軟體來進行描述性及推論性統計分析，以清楚描繪加護病房存活病患第一年的生理活動功能恢復及時間趨勢，並確認譫妄及重症系統性乏力對功能恢復的交互影響。這是國內第一個嘗試探討加護病房譫妄及重症系統性乏力並針對加護病房出院病患進行的生理活動功能追蹤研究，所得結果將可增進臨床及學界對加護病房譫妄及重症系統性乏力及後續功能恢復的瞭解，進而提供相應的護理照護計劃。<br> Abstract: Intensive Care Unit Acquired Delirium (ICU-AD) and Intensive Care Unit Acquired Weakness (ICU-AW) are common in critically ill, mechanically ventilated adult patients. As more patients survive ICU stays but suffer from long-term functional declines leading to unemployment and disability, research is urgently needed. The aims of this proposed study are to: 1) describe the trajectory of physical functions one year after ICU discharge, including distance walked in 6 minutes, hand grip, maximum inspiratory pressure, cognitive function, basic and instrumental activities of daily living (ADL/IADL), and whole body mass; 2) examine the incidences of ICU-AD and ICU-AW; and 3) test the interaction between ICU-AD and ICU-AW on one-year functional trajectories in the ICU survivors.For this 3-year prospective, longitudinal cohort study, consecutive adult patients (≧20 years) will be screened for enrollment at 6 ICUs in the National Taiwan University Hospital. Participants will be assessed daily for delirium occurrence during their ICU stays and at the ICU discharge, ICU-AW will be assessed using a scandalized protocol. Participants will be followed for one year after ICU discharge at 1, 3, 6, 12 months. A comprehensive functional evaluation (6-minute walking test, grip strength test, maximum inspiratory pressure test, mini-mental state exam, ADL/IADL questionnaires, and body impedance analysis) will be performed. Estimated 158 participants will be enrolled and followed for one year. Data will be analyzed using the SPSS package. The Generalized Estimating Equation (GEE) will be performed to delineate the trajectory of physical functions one year after ICU discharge and to test the interaction among ICU-AD, ICU-AW, and one-year functional trajectories. The findings will add to the development of nursing intervention program to reduce ICU-AD and ICU-AW, thus promoting functional recovery for ICU survivors.加護病房譫妄重症系統性乏力加護病房存活者功能下降呼吸肌肌力失能Intensive Care Unit Acquired DeliriumIntensive Care Unit Acquired WeaknessIntensive Care Unit SurvivorFunctional DeclineMaximum Inspiratory PressureDisability