氣管內管分泌物抽吸為插管之早產兒例行性的護理處置，而抽吸過程中易引起低血氧與心跳過慢等可能影響生命安全與腦部神經發展的生理反應。故本研究目的為發展以實證為基礎的早產兒氣管內管抽吸照護指引，提供護理人員現階段最適合的抽吸照護決策，並減少早產兒氣管抽吸時的生理壓力。
本研究方法涵蓋二大部分，（一）發展早產兒氣管內管抽吸照護指引：於南部某醫學中心之新生兒加護病房成立指引發展小組、分析現有的氣管抽吸指引及建構臨床問題、依臨床問題進行系統性文獻回顧與文獻評讀、撰擬臨床建議、進行共識決策程序、外部專家審核等六大步驟完成照護指引發展。（二）執行照護指引與評值成效：於指引發展場域宣傳執行本研究發展之照護指引，以及評值指引對早產兒之生理安全性與護理人員臨床使用之適用性成效結果。採單組前後測研究設計，探討插管使用呼吸器的早產兒接受氣管內管抽吸照護時之血氧飽和濃度與心跳速率等生理反應。以問卷調查及焦點團體訪談法，探討臨床護理人員對於指引使用之困難度、可行性與阻力等結果。
研究結果：（一）所發展之早產兒氣管內管抽吸照護指引含13個議題39個建議項目，依抽吸前中後流程呈現，經17位早產兒專家進行兩回合德菲法共識問卷調查，第一回合共識結果97%的建議項目達75%以上同意度，第二回合針對修訂的六項建議全達90%以上之同意度。四位專科專家整體評估推薦於臨床使用，三位方法學專家對指引發展品質整體評價為強烈建議與建議。（二）照護指引成效評值結果，五位早產兒個案進行氣管內管抽吸時SPO2於正常範圍，無發生＜85%之低血氧變化；HR抽吸中與抽吸後略高於基準值，無發生＜100次/分心跳過慢變化，抽吸後HR平均48.5秒恢復至基準值。29位護理人員進行問卷調查，大部分人員認為指引臨床上可行且容易做到，3.4-20.7%人員提到少數項目困難執行，困難的原因主要為個人認知與經驗習慣面臨改變。
本研究實證基礎發展的早產兒氣管內管抽吸照護指引，具品質與嚴謹度，可提供臨床插管之早產兒適切且安全的抽吸照護，指引臨床推行教育則需要加入人員困難與阻力考量，才能真正落實。

Endotracheal suctioning (ETS) for mechanically ventilated premature infants is routine practice in neonatal intensive care. However, ETS is associated with oxygen desaturation and bradycardia which might affect the neuromuscular development of infants. A clinical practice guideline based on empirical evidences is crucial for preventing adverse effects from suctioning. In Taiwan, little recommendation of ETS based on evidences has been made. In order to provide a safe and quality practice, the purpose of this study is to develop an evidence-based clinical practice guideline of ETS for premature infants.
Study design. This study concluded two parts: (1) to develop and implement an evidenced-based ETS guideline for premature infants. The Bowker et al (2009) development steps of national guidelines was applied. These steps include setting up a multidisplinary working group, systemic literature review of ETS, re-examining the content and constructing clinical key questions, drafting and amending the clinical recommendations, Delphi consensus decision-making process, and reviewed by external experts. (2) to evaluate the premature infants’ physiological responses and applicability while the ETS guideline is used. A one-group pre-post test design is used and the subjects are selected from a neonatal intensive care unit of medical center in southern Taiwan. Their physiological responses to ETS, including oxygen saturation and heart rate, after using the ETS guideline were measured to ensure the safety. In addition, the applicability of ETS guideline was evaluated by nurses using a semi-structure questionnaire and focus group interviews.
Results. (1) The ETS guideline included 13 issues and 39 recommendations. After being reviewed by 17 experts using Delphi method, 97% recommendations was approved with agreement beyond 75% at the first survey for consensus. All modified recommendations achieved agreement beyond 90% at the second survey for consensus. In addition, four neonatal specialists in medicine and nursing recommended that the guideline is feasiable and appropriate for clinical practice. The structure and quality of ETS guideline were examined and recognized by three methodologists. (2) When the was implemented, 5 premature infants’ cardiorespiratory responses to ETS were within normal ranges without oxygen desaturation (SpO2＜85%) or bradycardia (HR＜100 beat/min). Seventy-two percent nurse in NICU indicated that the ETS guideline was feasible and easy to implement. Few procedures difficult to be implemented were mainly resulted from personal misconcepts and habits..
The ETS practice guideline established from this study was evidence-based and can be widely applied in Taiwan. Further ETS education program for clinical practice needs to be focused.

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