臺灣博碩士論文加值系統

本研究在探討乳癌婦女乳房治療後疼痛症候群(PBTPS)及其相關症狀的強度變化型態及其相關因素。本研究採縱貫式研究設計，於病患術後第1、2、3、4、5、6、8、10、12、18及24個月以疼痛性質評估表(PQAS)、乳房(肩臂)症狀問卷(BSQ)及神經性疼痛皮膚感覺檢查測量患側乳房及肩臂疼痛及症狀。運用描述性統計、階層線性模式(Hierarchical Linear Model)進行資料分析。
分析符合收案標準之184位乳癌患者資料發現：(一) 術後二年內，乳房治療後疼痛症候群(PBTPS)發生率為75%，發生的型態大多是在是術後前半年發生。(二)手術後二年內乳房及肩臂神經性疼痛及相關症狀之盛行率會隨著時間降低。(三)術後二年內乳房及肩臂疼痛強度及相關症狀嚴重度的變化是呈現一次方的線性遞減趨勢。(四) 教育程度、手臂受傷與否、術後24-48小時有無顯著疼痛會影響乳房及肩臂疼痛強度變化；診斷時BMI及術後24-48小時有無顯著疼痛會影響乳房及肩臂症狀嚴重度變化。

The purposes of this study were to explore the change pattern of Post Breast Therapy Pain Syndrome (PBTPS) and associated symptoms and to identify the risk factors in women after breast surgery. A longitudinal design was used. Neuropathic pain and associated symptoms were measured using Pain Qualities Assessment Scale (PQAS), Breast Symptom Questionnaire (BSQ), and neurological examination at 1, 2, 3, 4, 5, 6, 8, 10, 12, 18, and 24 months after surgery. Descriptive statistics and multilevel analysis with Hierarchical Linear Model (HLM) were used to analyze the study data.
Data from 184 patients showed that: (1) The incidence of PBTPS during two years after surgery was 75%; most of the PBTPS occurred in the first 6 months after surgery. (2) The prevalence rates of neuropathic pain and associated symptoms during two years after surgery decreased with time. (3) Both the change pattern of pain intensity and symptom severity in breast and arm/ shoulder demonstrated a trend of linear decreasing. (4) Education, previous arm injury, and remarkable pain during 24-48 hours after surgery had significant effect on the change of pain intensity. BMI at diagnosis and remarkable pain during 24-48 hours after surgery had significant effect on the change of severity of the symptoms.

指導教授推薦書
口委審定書
授權書…………………………………………………………………iii
誌謝……………………………………………………………………iv
中文摘要………………………………………………………………vi
英文摘要……………………………………………………………… vii
目錄……………………………………………………………………viii
論文目次……………………………………………………………ix
表目錄………………………………………………………………xii
圖目錄………………………………………………………………xv
附錄目錄…………………………………………………………xviii
第一章 緒論………………………………………………………… 1
第一節 研究動機與重要………………………………………1
第二節 研究目的 ………………………………………………… 5
第三節 研究問題………………………………………………6
第四節 名詞界定………………………………………………… 7
第二章 文獻查證……………………………………………… 9
第一節 乳癌及其手術治療…………………………………… 9
第二節 乳房治療後疼痛症候群及其相關症狀得定義、特徵、發
生率和盛行率 …………………………………………14
第三節 乳房治療後疼痛症候群及其相關症狀的病生理機
轉……………………………………………………18
第四節 乳房治療後疼痛症候群及其相關症狀之測量……… 20
第五節 乳房治療後疼痛症候群及其相關症狀的變化……… 21
第六節 影響乳癌婦女乳房治療後疼痛症候群及其相關症狀之相關因素……………………………………………………23
第七節 乳房治療後疼痛症候群及其相關症狀之治療…………30
第八節 總結………………………………………………………32
第三章 研究方法………………………………………………… 33
第一節 研究架構……………………………………………… 33
第二節 研究設計……………………………………………… 34
第三節 研究場所與對象……………………………………… 35
第四節 樣本數估計…………………………………………… 36
第五節 研究工具……………………………………………… 37
第六節 資料收集過程 ……………………………………… 40
第七節 倫理考量……………………………………………… 42
第八節 資料處理與統計分析方法 ………………………… 43
第四章 研究結果與分析………………………………………… 48
第一節 乳癌病患基本人口學、疾病特性、治療屬性之描述性分
析………………………………………………………49
第二節 乳癌婦女術後二年內，乳房治療後疼痛症候(PBTPS)之發生率及其相關症狀的盛行率和嚴重度…………………56
第三節 乳癌婦女術後二年內，乳房及肩臂疼痛強度及其相關症
狀平均嚴重度之變化………………………………… 82
第四節 乳癌婦女術後乳房及肩臂疼痛強度之相關危險因素分
析…………………………………………………………87
第五節 乳癌婦女術後乳房及肩臂症狀平均嚴重度之相關危險因素分析………………………………………………… 97
第六節 乳癌婦女乳房及肩臂疼痛強度及其相關症狀平均嚴重度
變化之預測因子分析……………………………………110
第五章 討論……………………………………………………… 116
第一節 乳癌婦女在術後二年內，乳房治療後疼痛症候群
(PBTPS)發生率及相關症狀的盛行率和嚴重度……117
第二節 乳癌婦女在術後二年內，乳房及肩臂疼痛強度及其相關症狀嚴重度變化情形……………………………… 120
第三節 人口學、疾病治療特性與乳房及肩臂疼痛強度及其相關症狀嚴重度變化之間的相關性…………………… 122
第六章 結論與建議…………………………………………… 126
第一節 結論………………………………………………… 126
第二節 護理的應用………………………………………… 127
第三節 研究限制與建議…………………………………… 129
參考文獻………………………………………………………… 130

【表目錄】
表3-1 資料收集過程................................... 41
表3-2 研究問題資料分析方法........................... 43
表4-1 乳癌婦女人口學特性............................. 51
表4-2 乳癌術後婦女疾病特性與治療方式................. 54
表4-3 乳房/肩臂疼痛盛行率與強度...................... 58
表4-4 術後二年乳房部位常見疼痛性質之排序(%).......... 63
表4-5 術後二年肩臂部位常見疼痛性質之排序(%).......... 67
表4-6 乳房部位各症狀盛行率與嚴重度.................... 72
表4-7 肩臂部位各症狀盛行率與嚴重度.................... 74
表4-8 術後二年乳房及肩臂症狀平均嚴重度................ 76
表4-9 將沒有疼痛或症狀發生設定為0後之乳房與肩臂疼痛強度及
症狀平均嚴重度之平均值.......................... 83
表4-10 乳癌婦女術後疼痛強度零模式結果摘要.............. 83
表4-11 乳癌婦女術後乳房與肩臂症狀平均嚴重度零模式結果摘
要……………………………………………………… 84
表4-12 乳癌婦女術後疼痛強度時間線性變化結果摘要........ 85
表4-13 乳癌婦女術後乳房及肩臂症狀平均嚴重度時間線性變化結果
摘要……………………………………………………… 86
表4-14 影響乳房及肩臂疼痛強度及其變化的顯著因子總表.... 88
表4-15 教育程度與乳房及肩臂疼痛強度程度時間一次方變化結果
摘要………………………………………………………… 89
表4-16 手臂受傷與乳房及肩臂疼痛強度程度時間一次方變化結果摘
要…………………………………………………………… 91
表4-17 重建手術與否與乳房及肩臂疼痛強度程度時間一次方變化結
果摘要…………………………………………………… 92
表4-18 術後合併症與乳房及肩臂疼痛強度程度時間一次方變化結
果摘要…………………………………………………… 93
表4-19 術後24-48小時是否疼痛與乳房及肩臂疼痛強度程度時間一
次方變化結……………………………………………… 95
表4-20 影響乳房及肩臂症狀平均嚴重度及其變化的顯著因子總表
………………………………………………………… 98
表4-21 年齡與乳房及肩臂症狀平均嚴重度時間一次方變化結
果摘要…………………………………………………… 99
表4-22 BMI與乳房及肩臂症狀平均嚴重度時間一次方變化結果摘
要………………………………………………………… 100
表4-23 慣用手與否與乳房及肩臂症狀平均嚴重度時間一次方變化結
果摘要…………………………………………………… 102
表4-24 癌症期別與乳房及肩臂症狀平均嚴重度時間一次方變化結
果摘要…………………………………………………… 103
表4-25 肋間臂神經是否受損與乳房及肩臂症狀平均嚴重度時間一次
方變化結摘要…………………………………………… 105
表4-26 重建手術與否與乳房及肩臂症狀平均嚴重度時間一次
方變化結摘要…………………………………………… 106
表4-27 術後24-48小時是否疼痛與乳房及肩臂症狀平均嚴重度時
間一次方變化結摘要…………………………………… 107
表4-28 化學治療與乳房及肩臂症狀平均嚴重度時間一次方變化結
果摘要…………………………………………………… 109
表4-29 乳房疼痛強度預測因子之多變項分析………………… 111
表4-30 肩臂疼痛強度預測因子之多變項分析………………… 112
表4-31 乳房症狀平均嚴重度預測因子之多變項分析………… 113
表4-32 肩臂症狀平均嚴重度預測因子之多變項分析………… 115





【圖目錄】
圖3-1 研究架構圖...................................... 33
圖4-1 乳癌病人術後二年乳房及肩臂部位疼痛盛行率........ 59
圖4-2 乳癌病人術後二年乳房及肩臂部位疼痛強度變化...... 60
圖4-3 乳癌病人術後二年乳房部位疼痛性質盛行率變化...... 65
圖4-4 乳癌病人術後二年乳房部位疼痛性質強度變化........ 66
圖4-5 乳癌病人術後二年肩臂部位疼痛性質盛行率變化...... 69
圖4-6 乳癌病人術後二年肩臂部位疼痛性質強度變化........ 70
圖4-7 術後二年乳房部位各症狀盛行率.................... 73
圖4-8 術後二年乳房部位各症狀嚴重度.................... 73
圖4-9 術後二年肩臂部位各症狀盛行率.................... 75
圖4-10 術後二年肩臂部位各症狀嚴重度................... 75
圖4-11 術後二年乳房及肩臂部位症狀平均嚴重度變化....... 77
圖4-12 術後二年乳房部位客觀資料-痛覺異常情形.......... 79
圖4-13 術後二年肩臂部位客觀資料-痛覺異常情形.......... 80
圖4-14 術後二年乳房/肩臂部位客觀資料-觸摸痛情形....... 81
圖4-15乳癌病患術後二十四個月乳房及肩臂疼痛強度線性變化
……………………………………………………………… 85
圖4-16 乳癌病患術後二十四個月乳房及肩臂症狀平均嚴重度線性變
化………………………………………………………… 86
圖4-17 乳癌病患術後24個月內教育程度與乳房疼痛強度關係… 90
圖4-18 乳癌病患術後24個月內手臂受傷與乳房疼痛強度關係… 91
圖4-19 乳癌病患術後24個月內是否接受重建手術與乳房疼痛強度
關係……………………………………………………… 92
圖4-20 乳癌病患術後24個月內是否有無合併症與肩臂疼痛強度
關係……………………………………………………… 94
圖4-21 乳癌病患術後24個月內其術後24-48小時是否有顯著疼痛與
乳房疼痛強度關係………………………………………… 95
圖4-22 乳癌病患術後24個月內其術後24-48小時是否有顯著疼痛與
肩臂疼痛強度關係………………………………………… 96
圖4-23 乳癌病患術後24個月內年齡與乳房症狀平均嚴重度關
係………………………………………………………… 99
圖4-24 乳癌病患術後24個月內BMI與乳房症狀平均嚴重度關
係…………………………………………………………101
圖4-25 乳癌病患術後24個月內BMI與肩臂症狀平均嚴重度關
係…………………………………………………………101
圖4-26 乳癌病患術後24個月內慣用手與否與肩臂症狀平均嚴重度
關係…………………………………………………………102
圖4-27 乳癌病患術後24個月內癌症期別與肩臂症狀平均嚴重度
關係…………………………………………………………104
圖4-28 乳癌病患術後24個月內肋間臂神經是否受損與乳房症狀平
均嚴重度關係……………………………………………105
圖4-29 乳癌病患術後24個月內是否接受重建手術與肩臂症狀平
均嚴重度關係……………………………………………106
圖4-30 乳癌病患術後24個月內其術後24-48小時是否有顯著疼痛情
形與乳房症狀平均嚴重度關係……………………………108
圖4-31 乳癌病患術後24個月內其術後24-48小時是否有顯著疼痛情
形與肩臂症狀平均嚴重度關係……………………………108
圖4-32 乳癌病患術後24個月內化學治療與肩臂症狀平均嚴重度
關係…………………………………………………………109






【附錄目錄】
附錄一 乳房術後症狀研究受試者同意書…………………………149
附錄二 基本資料表…………………………………………………151
附錄三 手術醫療紀錄單……………………………………………158
附錄四 術後疼痛強度………………………………………………161
附錄五 治療紀錄單…………………………………………………162
附錄六 患側乳房(肩臂)疼痛性質評估表(Pain Qualities Assessment Scale；PQAS)……………………………………………169
附錄七 乳房(肩臂)症狀問卷………………………………………179
附錄八 乳癌病人術後患側乳房疼痛性質評估表(Pain Qualities Assessment Scale；PQAS)各疼痛性質或種類發生情形…181
附錄九 乳癌病人術後患側乳房疼痛性質評估表(Pain Qualities Assessment Scale；PQAS)各疼痛性質或種類強度………183
附錄十 乳癌病人術後患側肩臂疼痛性質評估表(Pain Qualities Assessment Scale；PQAS)各疼痛性質或種類發生情形…186
附錄十一 乳癌病人術後患側肩臂疼痛性質評估表(Pain Qualities Assessment Scale；PQAS)各疼痛性質或種類強度………188
附錄十二 痛覺異常客觀資料………………………………………191
附錄十三 乳房治療後疼痛症候群發生類型………………………193
附錄十四 乳癌婦女術後乳房及肩臂疼痛強度之不顯著相關因子…………………………………………………………194
附錄十五 乳癌婦女術後乳房及肩臂症狀平均嚴重度之不顯著相關因子…………………………………………………………202

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