| Summary: | 碩士 === 國立陽明大學 === 臨床護理研究所 === 89 === Abstract
A cross-session, quasi-experimental design was used to examine the effect of body position on gas exchange in the patients with unilateral tuberculous pleural effusions. Twenty-one patients proved with TB pleurisy obtained from a medical center were included for this study. Pulmonary function testing was performed in the sitting position and analyses of arterial blood gases were measured in 5 positions randomly. Statistical significance analysis was carried out by using descriptive analysis, Spearman correlation, Wilcoxon signed rank test, and ANOVA test. The results of the study were summarized as follows:
1.The mean values of PaO2 were highest in the sitting position (PaO2-Si), followed by prone position (PaO2-P), the lateral decubitus position with the normal side down (PaO2-N), the lateral decubitus position with the effusion side down (PaO2-E), and the supine position (PaO2-Su). On the contrary, the mean values of alveolar-arterial PO2 gradient [Aa(PaO2)] were largest in the supine position [Aa(PaO2)-Su], followed by the lateral decubitus position with the effusion side down [Aa(PaO2)-E], the lateral decubitus position with the normal side down[Aa(PaO2)-N], the prone position[Aa(PaO2)-P], and the sitting position [Aa(PaO2)-Si].
2.To evaluate the effect of effusion amount upon on gas exchange in different positions, the data of PaO2-Si, PaO2-Su, and PaO2-E in the patients with small amount were significantly higher than data in those with large amount. In addition, The PaO2-N, PaO2-E, and PaO2-P of the patient with small amount were significantly higher than those with medium amount.
3.For the patients with unilateral tuberculous pleural effusions, PaO2-Si was significantly higher than PaO2-Su; in contrast, [Aa(PaO2)-Su] was significantly higher than [Aa(PaO2)-Si] and [Aa(PaO2)-P].
4.For the patients with unilateral tuberculous pleural effusions, we found that gas exchange was affected by effusion amount and body position. The difference of PaO2 between supine and sitting positions (PaO2-Su minus PaO2-Si) was significantly greater in the patients with medium amount than those with small amount. The difference of PaO2 between prone and supine positions (PaO2-P minus PaO2-Su) also showed significant difference between the patients with varying amount of effusions.
5.The difference of Aa(PO2) between two lateral decubitus postions, [Aa(PO2)-N minus Aa(PO2)-E] showed a significantly positive correlation with the values of FEV1 (% of pred.), FVC (% of pred.), and TLC (% of pred.).
The results of this study may have an impact on nursing practice, nursing education and further studies. In nursing practice, the changes of body positions for the patients with unilateral tuberculous pleural effusions should consider the effusion amount. The priority of postures recommended is sitting position, followed by prone position; and supine position is not recommended. The pulse oximetry should be used to monitor the gas exchange when changing body positions. In nursing education, the results of this study could be incorporated into the lecture of in-service education program. For ongoing studies, a longitudinal study to evaluate the effect of decreasing amount of effusion on gas exchange in the patients with tuberculous pleurisy undergoing anti-tuberculosis therapy in needed. In addition, large series studies are needed to verify the results of the present study.
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