第五章 結論與建議
第三節 研究限制與建議
一、研究限制
本研究收案採立意取樣，收案期間共計 8 個月，雖收案樣本數達 40 位符合 收案標準，惟因受限於個案來源必須是臨床實際發生才能收案，且臨床針對嚴重 腦部損傷使用鎮靜療法或進行顱骨切除術病人，為避免顱內壓過高故開立醫囑執 行胸腔震顫物理治療者較少，因此兩組樣本數在有無鎮靜劑及有無接受顱骨切除 術比例差異較大，用於推論兩組間差異稍顯不足，未來在後續的研究中若能增加 鎮靜劑使用及有顱骨切除數者之樣本數，擴大研究對象、明確的實證分析，更強 化分析結果。
本研究收案場所於北部某醫學中心的腦神經外科加護病房，為配合病人病程 進展，研究設計中原期望以收案對象初次的胸腔震顫物理治療為測量一致的時 機，惟因胸腔震顫物理治療醫囑開立的時間點不一，有的在早上已由呼吸治療師 進行初次的胸腔震顫物理治療，研究者僅能執行第二次、甚至第三次的胸腔震顫 物理治療，因此無法在執行的時間點上做更進一步的分析。
二、研究建議
國內外研究在腦部損傷病人之照護準則皆強調控制顱內壓、腦灌流壓，也不 乏探討顱內壓、腦灌流壓之最適當值與病人預後、死亡率、失能間的臨床研究，
然而一旦瞭解這些生理數值的照護準則外，臨床仍有不少無可避免的處置及護理 活動會影響這些有意義的監控數據，透過本研究結果發現腦部損傷病人執行胸腔 震顫物理治療，應更審慎的評估、確認處置的必要性，並建立良好的處置標準流 程，使之對病人之各項生理參數影響層面減低，避免處置造成的二度腦損傷情 形，因此建議未來研究能將相關處置標準化，以建立安全的處置照護。
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腦部損傷病人執行胸腔震顫物理治療記錄表
編號 收案日期
第一部分
姓名 性別
年齡 診斷
入院日期 使用呼吸器 有□ 無□
手術日期 顱骨減壓術 有□ 無□
昏迷指數 E□ V□ M□ 使用鎮靜劑 有□ 無□
第二部分
時間 MAP ICP CPP SPO2 備註
附錄一 資料收集表
附錄一 資料收集表