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系統識別號 U0026-0109201502370700
論文名稱(中文) 循環性照明對早產兒睡眠型態的影響
論文名稱(英文) The Effect of Cycled Lighting on Sleep Patterns in Premature Infants
校院名稱 成功大學
系所名稱(中) 健康照護科學研究所
系所名稱(英) Institute of Allied Health Sciences
學年度 103
學期 2
出版年 104
研究生(中文) 楊素珍
研究生(英文) Shu-Chen Yang
學號 TA8941071
學位類別 博士
語文別 英文
論文頁數 118頁
口試委員 指導教授-張瑩如
口試委員-林其和
召集委員-洪志秀
口試委員-陸偉明
指導教授-李慈音
中文關鍵字 早產兒  循環照明  睡眠型態 
英文關鍵字 premature infants  cycled lighting  sleeping pattern 
學科別分類
中文摘要 目前國內早產兒加護病房及病嬰室的照護環境中,常使得早產兒處於低照明或是無規律照明的情境下。因此,離開子宮的早產兒頓時失去了由母親所提供的日夜節律訊息,如此將導致早產兒往後日夜節律發展的困難,也對早產兒的生理穩定及成長有所影響。因此,本研究主要目的是了解早產兒睡眠型態的發展狀況,並探討循環性照明對早產兒睡眠型態的影響。
本研究採實驗性研究設計,於中部及南部某醫學中心的新生兒加護病房及病嬰室,選取46位妊娠滿32週以上的早產兒為研究對象,以區段式隨機分派為兩組,一組為低照明(對照)組:全天在保溫箱上覆蓋不透光蓋布,以維持低照明強度(小於25Lux),另一組為循環照明(實驗)組:只在晚上覆蓋包布於保溫箱上,其餘時間移除蓋布,讓早產兒暴露於室內的燈光(維持200-300Lux)。實驗介入為期2週,在實驗前3天及實驗介入期間的第5-7天及第12-14天,持續收集早產兒睡眠清醒之72小時資料進行分析。研究工具以TES-1332光照度計進行光線監測,並將Atiwatch-L放置於個案的手腕進行活動評估,統計分析以Cosinor analysis法分析身體活動節律之型式,並以廣義估計方程式(GEE)檢定兩組在實驗前後之睡眠型態的差異。
研究結果發現:(1)矯正年齡約34週的早產兒每日的睡眠時間平均為17.9±1.3小時,清醒時間為6.1±1.3小時,平均睡眠時間約佔全日74.9%,清醒時間約佔全日25.4%,睡眠仍占大部分時間,全日睡眠與清醒時間的比率約為7:3。(2)每一睡眠清醒週期的平均持續時間為96.1±17.9分鐘,一天平均有15.5±3.1個睡眠清醒週期。(3)日夜之平均睡眠及清醒時數均未呈現顯著差異。(4)矯正年齡接近34週的早產兒未呈現身體活動之日變節律或短日節律。(5)循環性照明介入1週內,循環性照明組與全天低照明組,其睡眠清醒週期持續時間、日間清醒及睡眠時間均無顯著差異。(6)循環性照明介入長達2週時,循環性照明組較全天低照明組能有效增長睡眠清醒週期持續時間及夜間睡眠時間,也能有效減少夜間清醒時間。
本研究建議於早產兒出院前2週實行光線的日夜調控,將有助於早產兒建立穩固的睡眠型態。護理人員可將睡眠型態作為早產兒發展評估及照護成效之指標。
英文摘要 The care environment of the current ICU wards for premature infants and infant wards tend to expose premature infants to low level lighting or irregular lighting. Therefore, premature infants who leave mother’s uterus early suddenly lose the information of circadian rhythms provided by mother, which will lead to the difficulty in their future development of circadian rhythms, as well as affect their physiological stabilization and growth. Therefore, the main purpose of this study is to understand the development of sleeping pattern of premature infants, as well as to investigate the influence of cycled lighting on their sleeping pattern.
This experimental study enrolled 46 premature infants over the age of 32 weeks at neonatal ICU wards and sick baby rooms in two medical centers in the central and southern Taiwan. The subjects were randomly assigned into two groups. One was the dim lighting group (control group) in which the infant incubators were covered with opaque wrapping clothes to maintain dim light intensity (<25Lux) whole day. The other was the cycled lighting group (experimental group) in which the infant incubators were covered with opaque wrapping clothes at night only, and were not covered at the rest of time to expose premature infants to indoor lighting (maintained at 200-300Lux). The experimental intervention lasted for 2 weeks. This study collected 72-hour data of premature infants 3 days before the experimental intervention and on Days 5-7 and Days 12-14 during the experimental intervention. The TES-1332 digital light meter was used to monitor the lighting. The Atiwatch-L placed on the wrists of the subjects was used to assess infants’ sleep. This study used Cosinor analysis to analyze rhythm of physical activity and used generalized estimating equation (GEE) to examine the difference in sleeping patterns between two groups.
Research results showed that: (1) the average number of hours of sleep of premature infants at corrected age of 34 weeks was 17.9±1.3 hours, and the waking time was 6.1±1.3 hours. Their average number of hours of sleep accounted for 74.9% of whole day, and that of waking time accounted for 25.4% of whole day. Sleep still accounted for most of the time of whole day. The ratio of sleep and waking time of whole day was approximately 7: 3; (2) the average duration of each sleep-awake cycle was 96.1±17.9 minutes. The subjects experienced an average of 15.5±3.1 sleep-wake cycles; (3) there was no significant difference in average number of hours of sleep and waking time between daytime and nighttime; (4) the physical activities of premature infants at corrected age of 34 weeks did not reflect circadian rhythm or infradian rhythm; (5) there was no significant difference in duration of sleep-wake cycle, waking, and sleeping time at daytime and nighttime between the experimental and control groups at day 5-7; (6) after 2-week intervention of cycled lighting, compared with control group, the sleep-wake cycle duration, and sleeping time at nighttime were significantly increased, and their waking time at nighttime was significantly decreased.
Premature infants are advised to receive cycled lighting 2 weeks before they are discharged from the hospital, which can help them develop stable sleeping pattern. Nursing personnel are advised to use sleeping pattern as the index for assessing development of premature infants and effectiveness of care.
論文目次 Abstract in Chinese...........................................................................................................I
Abstract .............................................................................................................................Ⅲ
Acknowledgement..........................................................................................................Ⅵ
Table of Contents………………………………………………………………………Ⅶ
List of Tables……………………………………………………………………............Ⅹ
List of Figures…………………………………………………………………………..XI
Appendix…………………………………………………………………….XI
ChapterⅠ Introduction
Research Background and Significance….....................................................................1
Specific Aims.................................................................................................................4
Research Questions........................................................................................................5
ChapterⅡ Literature Review
Development of Sleep-wake Pattern..............................................................................6
Development of Physiological Rhythm.........................................................................9
Influence of Light on Premature Infants......................................................................17
Other Factors Affecting Sleeping Pattern....................................................................24
Assessment on Sleeping and Waking Pattern..............................................................29
Research Framework…................................................................................................42
Definition of Terms......................................................................................................44
Chapter Ⅲ Research Method
Research Design…........................................................................................................46
Subjects…………..........................................................................................................48
Instrument………..........................................................................................................49
Procedures of Data Collection.......................................................................................52
Data Analysis………….................................................................................................54
Chapter Ⅳ Results
Demographic Characteristics of Subjects.....................................................................56
Distribution of Whole Day Sleep and Waking Time....................................................62
Duration of Sleep-wake Cycle of Premature Infants…................................................63
Differences in Daytime/nighttime Sleep and Waking Time.........................................64
Rhythm of Physical Activity….....................................................................................65
Effect of Cycled Lighting on Sleeping Pattern..............................................................66
Chapter Ⅴ Discussion
Distribution of Daily Sleep and Waking Time…..........................................................78
Duration of Sleep-wake Cycles of Premature Infants...................................................79
Difference in Daytime/Nighttime Sleeping Patterns.....................................................81
Rhythm of Physical Activity in Premature Infants………............................................83
Effect of Cycled Lighting on Sleep-awake Patterns……..............................................85
Chapter Ⅵ Conclusion and Suggestions
Conclusion.....................................................................................................................89
Applications...................................................................................................................91
Research Limitations….................................................................................................93
References.......................................................................................................................94
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