比較床上沐浴方式對於重症病人體溫及心跳之影響：前驅試驗

Comparison of Body Temperature and Heart Rate Variations Between Two Bed Bathing Practices for Critically Ill Patients: A Pilot Study

背景：適當的身體清潔可降低感染風險、維持個人衛生及增加病人舒適，因此發展安全並有效益的沐浴方式對於臨床相當重要。而目前的研究中較少對沐浴過程病人體溫及心跳變化的探討。本研究的目的為探討傳統沐浴與擦澡巾擦澡對於重症病人體溫、心跳、沐浴時間及皮膚清潔之成效。方法：本研究為前驅試驗，採實驗性研究設計，以隨機分派方式將收案對象分配至「擦澡巾組」及「傳統沐浴組」。採自擬式結構式調查表進行每次沐浴的評估及皮膚採檢。資料分析使用平均數、標準差、卡方檢定、t檢定及重覆測量變數分析。結果：共計收案30位，兩種沐浴方式在沐浴前後體溫及心跳的變化無顯著差異。而擦澡巾組花費的時間為21.3＋6.8分鐘，而傳統沐浴組則花費33.4+7.0分鐘，擦澡巾組的護理時數上顯著低於傳統沐浴組。但兩種沐浴方式對於沐浴前後的皮膚菌落數無差異。結論：兩種沐浴方式對於降低皮膚菌落數及心跳變化無顯著差異，但擦澡巾擦澡在護理時數上低於傳統沐浴。本研究結果可提供臨床護理人員協助病人沐浴時照護決策依據。

Background: Bathing critically ill patients can decrease their risk of infection, thereby maintaining their personal hygiene and increasing comfort. Safe and effective bed baths are crucial. Studies on body temperature and heart rate variation during bathing are lacking. The purpose of this study was to compare the effects of two bathing practices, namely basin and disposable cloth baths, on body temperature and heart rate variations, bathing time, and microbial skin counts. Method: We designed a randomized clinical trial to evaluate the effects of basin and disposable cloth baths on 30 patients in an intensive care unit. Patients were randomized in a 1:1 ratio or each group had equal number of patients. Investigators measured bathing time, body temperature and heart rate during bathing, and bathing costs. Skin cultures were obtained before and after bathing. Results: We enrolled 30 patients in the study. No significant differences in body temperature and heart variations between the two groups were observed. The bathing times were 33.4 ± 7.0 min and 21.3 ± 6.8 min for the basin and disposable cloth bath groups, respectively. The disposable cloth bath group had significantly shorter bathing times. The microbial skin counts were not significantly different between the two groups. Conclusion: Body temperature and heart rate were not significantly different between the two groups during bathing. However, disposable cloth bathing practice can decrease bathing time. Therefore, disposable cloth bathing may be a desirable option in critical care settings. The present study provides information for making decisions related to bathing in clinical care settings.