臺灣博碩士論文加值系統

本研究旨在了解肥胖症患者於腹腔鏡胃繞道手術前後之生活品質差異狀況， 並對肥胖患者生活品質之影響因子進行分析探討。採類實驗性研究設計及立意取樣方式。本研究對象肥胖患者定義乃指BMI 値超過40 kg/㎡ 或BMI≧ 35 kg/㎡ 已合併有因肥胖引起如糖尿病、高血壓等疾病者， 接受腹腔鏡胃繞道手術的肥胖症患者， 分別於手術前及手術後三個月給予生理弁鉞�估及結構式問卷調查。統計分析包括： 描述性統計、t-檢定、皮爾森積差相關、複迴歸分析、成對t 檢定。研究結果總收案數為40 份，平均年齡為19 歲至51 歲。影響肥胖患者手術前後生活品質之預測因子為教育程度、婚姻、飲食狀態、BMI 値及體重。生活品質分析結果， SF-36 八個構面中， 除了活力狀況(VT)構面未達顯著差異外， 其餘七個構面， 均達統計顯著差異。本研究結果除測量肥胖患者減重手術後患者生活品質之變化， 亦可針對患者個別性之差異， 提供對肥胖症正確認知及手術後自我照顧的技能， 尤其是如何面對及適應飲食型態的改變， 以達手術後良好的體重控制，另外， 亦可作為未來對肥胖者健康照護策略制定方向的參考。

The purpose of this study was to investigate the difference between the quality of life of obesity patients before and after Larparoscopic Gastric Bypass Surgery (LGBS), and to examine the predictors of the quality of life of obesity patients. Quasi-experimental design and purposive sampling were used in this clinical trial. Inclusion criteria of the participants included BMI over 40 kg/㎡ , or BMI≧ 35 kg/㎡ combined with DM/hypertension diseases, and with LGBS therapy. Data were collected before and after surgery (three months later) of forty obesity patients by using demographic characteristics and short-form 36 health survey. Statistical analysis methods included descriptive statistics, t-test, Pearson’s product-moment correction, and multiple-regression analysis. Results showed education, marital status, dietary status, BMI value, and body weight explain 51.1% of variances on quality of life of participants after surgery. Moreover, seven sections (physical functioning、role physical 、bodily pain 、general health 、social functioning 、role-emotional、mental health) quality of life showed significant difference after surgery. Nursing implications not only indicated the benefits from LGBS but also helped participants to promote their self-care skills and better quality of life.

目 錄
中文摘要·············································································· i
英文摘要·············································································· iv
致謝····················································································· ivi
目錄····················································································· iv
圖表目錄·············································································· vii
第一章 緒論········································································· 1
第一節 研究動機與重要性············································· 1
第二節 研究目的··························································· 3
第三節 研究架構··························································· 4
第四節 研究假設··························································· 5
第五節 名詞界定··························································· 6
第二章 文獻查證·································································· 8
第一節 肥胖的定義······················································· 8
第二節 肥胖的盛行率···················································· 10
第三節 肥胖對健康的影響············································ 13
第四節 減重手術介紹···················································· 17
第五節 生活品質定義與相關研究·································· 20
第三章 研究方法·································································· 36
第一節 研究設計·························································· 36
第二節 研究對象·························································· 36
第三節 資料收集過程··················································· 37
第四節 研究工具·························································· 38
第五節 研究工具之信、效度········································ 39
第六節 倫理考量·························································· 41
第七節 資料分析過程··················································· 42
第四章 研究結果·································································· 45
第一節 肥胖患者基本屬性之描述································· 45
第二節 肥胖患者疾病特性之描述································· 49
第三節 肥胖患者的生活品質········································ 51
第四節 肥胖患者基本屬性、疾病特性與生活品質之相關性····························································· 59
第五節 肥胖患者生活品質之迴歸預測模式··················· 69
第六節 肥胖患者施行減重手術前後的生活品質比較···· 74
第五章 討論········································································· 76
第一節 肥胖症患者基本屬性、疾病特性之探討··········· 76
第二節 肥胖症患者基本屬性、疾病特性與生活品質之
關係································································· 79
第三節 肥胖患者生活品質之預測因子························· 81
第四節 肥胖患者手術前後生活品質差異情形··············· 83
第六章 結論········································································ 84
第一節 結論································································ 84
第二節 研究限制························································ 86
第三節 研究應用與貢獻·············································· 86
參考文獻·············································································· 88
中文部份·········································································· 88
英文部份·········································································· 91
附錄一 同意書(SF-36 問卷台灣版授權使用) ························· 99
附錄二 同意臨床試驗證明書················································ 100
附錄三 研究問卷說明及同意書············································ 101
附錄四 研究問卷基本資料··················································· 102
附錄五 SF-36 台灣版問卷···················································· 103

圖表目錄
圖一 研究架構····································································· 4
圖二 SF-36 和SF12 的測量模型········································· 24
圖三 肥胖患者手術前後體重分佈圖····································· 49
表1 世界衛生組織於1998 年對肥胖之定義·························· 5
表2-1 各地區肥胖與BMI 值分類標準··································· 13
表2-2 肥胖與健康危險之關聯·············································· 14
表3 SF-36 反轉分數與刻度校正值······································· 27
表4 SF-36 構面分數轉換值對照表········································ 28
表5 肥胖症與生活品質之相關研究······································· 35
表6 研究工具信度檢定························································ 40
表7 研究目的、研究架構與統計方法··································· 44
表8 肥胖患者基本屬性分佈情形·········································· 46
表9 肥胖患者飲食型態手術前後分佈情形···························· 48
表10 肥胖患者慢性併發症分佈情形····································· 49
表11 肥胖患者手術前後體重及BMI 值分佈情形·················· 50
表12 肥胖患者手術前後生活品質各構面之得分情形············ 53
表13 肥胖患者手術前生活品質量表各細項得分情形············ 55
表14 肥胖患者手術後生活品質量表各細項得分情形············ 57
表15 肥胖患者基本屬性、疾病特性與生理面向(PCS)生活品質之相關性···································································· 61
表16 肥胖患者基本屬性、疾病特性與心理面向(MCS)生活品質之相關性································································· 65
表17 手術前生理面向(PCS)生活品質影響因素之線性迴歸分析結果········································································· 72
表18 手術前心理面向(MCS)生活品質影響因素之線性迴歸分析結果········································································· 73
表19 手術後生理面向(PCS)生活品質影響因素之線性迴歸分析結果········································································· 73
表20 手術後心理面向(MCS)生活品質影響因素之線性迴歸分析結果········································································· 73

參 考 文 獻
中文部份
王文中(2000)．統計學與Excel 資料分析之實習應用．台北：博碩文化。
王國恩(2003)．減重決策與其經濟效益之研究．未發表之碩士論文．台北：國立臺灣大學農業經濟研究所。
民生報(2006)．推動健康飲食從擬]開始． 2006 年8 月12 日取自http://www.udn.com/2006/6/19/NEWS/LIFE/X3/3363782.shtml。
行政院衛生署(2005)．台灣地區2010 年衛生指標白皮書(94 年版)．2006年9 月12 日取自http://www.doh.gov.tw/ufile/doc/200601_.pdf。
李佳霙(1996)．探討中部五縣市民眾的健康狀況與醫療利用間的相關研究：SF-36 健康量表的合適性．未發表之碩士論文．台中：中國醫藥學院環境醫學研究所。
李易蓁(1997)．中文版SF-36 在臨床施測之初探．未發表之碩士論文．高雄：高雄醫學院公共衛生學研究所。
李威傑(2002)．肥胖症的外科治療．台灣醫學，6(1)，64-69。
李采娟、劉秋松、林正介、李毅達、賴俊雄、李佳霙（2005）．中文版SF-36健康量表使用於健康檢查民衆的信效度評估．中臺灣醫學科學雜誌，10（1）， 8－17。
林瓊華(2002)．社區更年期婦女生活品質及其相關因素之探討．未發表之碩士論文．台北：國立台北護理學院護理研究所。
姚開屏(2002)．臺灣版世界衛生組織生活品質問卷之發展與應用．臺灣醫學，6(3)，193-200。
洪麗珍、普天間弘(1995)．肥胖、中央肥胖與高血壓盛行率關係之探討—梧棲鎮社區性調查．弘光醫專學報，26，33-48。
陳桂敏(2003)．實用護理研究：指引、評論及運用第四版(下)．台中：滄海。
黃天祥(2002)．肥胖症之新進展．台灣醫學，6(1)，40-40。
黃致錕(2006)．現代人的夢魘－談肥胖及病態性肥胖．義大醫訊，2(13)，1-4。
張育菁(2004)．台灣地區肥胖與過重對醫療利用之影響．未發表之碩士論文．台北：陽明大學醫務管理研究所。
張瑛瑛、劉雪娥（2000）．子宮根除術後婦女生活品質之初探．長庚護理，11（4），1-10。
野側�(1998)．全人工髖關節置換術術前與術後健康相關生活品質之比較．未發表之碩士論文．高雄：高雄醫學院公共衛生學研究所。
潘文涵等(2004)．肥胖臨床診斷與治療．台北：台灣肥胖醫學會。
劉家鴻、吳岱穎、郭冠良、陳建志、林光洋、黃惠娟（2005）．過重與肥胖．基層醫學，20（9），219-231。
劉雪娥（1993）．家屬生活品質量表心理測定學之探討．護理研究，1（2），27-135。
盧令儀(2000)．某教學醫院冠狀動脈疾病病患施行心臟相關手術術後生活品質之探討．未發表之碩士論文．台北：長庚大學管理學研究所醫務管理組。
薛淑青(1999)．論量計酬與論病例計酬支付制度對醫療費用與品質之影響－以全人工髖關節置換術為例．未發表之碩士論文．高雄：高雄醫學院公共衛生學研究所。
英文部分
Aaronson, N. K. (1993). Assessment of quality of life and benefits from adjuvant therapies in breast cancer. Recent Results in Cancer, 127,8-13.
Aaronson, N. K. (1988). Quality of life: What is it? How should it be measured? Oncology, 2, 69-74.
Alexander, P.N., ＆ Jay, B.P. (2004). Surgical management of obesity.Clinical Obstetrics Gynecology, 47, 928-941.
Bayley, K. B., London, M. R., Grunkemeier, G. L., ＆ D. J. Lansky.(1995). Measuring the Success of Treatment in Patient Terms. Medical Care, 33, 226-35.
Books, R. G. (1995). Health status measurement: A perspective on change. London: MacMillan Press.
Calle, E.E., Thun, M.J., ＆ Petrelli, J.M. (1999). Body-mass index and mortality in a prospective cohort of U.S. adults. New England journal of medicine, 341, 1097-1105.
Cella, D. F., Tulsky, D. K, Graay, G., Sarafian, B., Linn, E., Bonomi, A., Siberman, M., et al. (1993). The functional assessment of cancer therapy scale: Development and validation of the general measure. Journal of Clinical Oncology, 11(3), 570-579.
Chan, J. M., Stampfer, M. J., Rimm, E. B., Willett, W. C., ＆ Colditz, G.A. (1994). Obesity, fat distribution, and weight gain as risk factors for clinical diabetes in men. Diabetes Care, 17(9), 961-969.
Christou, N.V., Sampalis, J.S., ＆ Liberman, M. (2004). Surgery decreases long-term mortality, morbidity and health care use in morbidly obese patients. Annals of Surgery, 240, 416-424.
Colditz, G., Willet, W., ＆ Stampfer, M., (1990) Weight as a risk factor for clinical diabetes in women. American Journal of Epidemiology, 132, 501-513.
Dahl, B., Gehrchen, P. M., ＆ Kieer, T. (2001) Nonorganic pain drawings are associated with low psychological scores on the preoperative SF-36 questionnaire in patients with chronic low back pain. European Spine Journal, 10, 211-214.
Dorn, J. M., Schisterman, E. F., ＆ Winkelstein, W. (1997) Body mass index and mortality in a general population sample of men and women. The Buffalo Health Study. American Journal of Epidemiology, 146, 919-931.
Ferrans, C. E., & Powers, M. J. (1992). Psychometric assessment of the quality of life index. Research in Nursing and Health, 15, 29-38.
Fontaine, K. R., ＆ Barofsky, I. (2001). Obesity and health-related quality of life. obesity reviews, 2, 173-182.
Gatchel, R., Mayer, T., ＆ Dersh, J. (1999). The association of the SF-36 health status survey with 1-year socioeconomic outcomes in a chronically disabled spinal disorder population. Spine, 24, 2162-2170.
Glassman, S.D., Dimar, J.R., ＆Johnson, J.R. (1998). Preoperative SF-36 responses as a predictor of reoperation following lumbar fusion. Orthopedics , 21, 1201-1203.
Herpertz, S., Kielmann, R., Wolf, A.M., Hebebrand, J. (2004). Do psychosocial variables predict weight loss or mental health after obesity surgery？ A systematic review. Obesity Research, 12(10), 1554-1569.
Hollingworth, W., Dixon, A.K., ＆ Todd, C.J. (1998) Self-reported health status and magnetic resonance imaging findings in patients with low back pain. European Spine Journal, 7, 369-375.
Hu, F. C. (2001). Designs and statistical methods for medical research. Taipei: National Taiwan University College of Public Health.
Jennifer, R. M., & Jack, A.Y. (2004). Treatment of Childhood and Adolescent Obesity. The Endocrinologist, 14, 138-143.
John, G. Kral., Lars, V. Sjostrom., ＆ Sullivan, M.B.E. (1992). Assessment of quality of life before and after surgery for severe obesity. American Society for Clinical Nutrition, 55, 6l lS-614S.
Jenkinson, C., Coulter, A., ＆Wright, L. (1993). The Short Form 36 (SF-36) Health Survey Questionnaire: Normative data for adults of working age. British Medical Journal, 306, 1437-1440.
Jette, D. U., ＆ Downing, J. (1996). The relationship of cardiovascular and psychological impairments to the health status of patients enrolled in cardiac rehabilitation programs. Physical Therapy, 76, 130-139.
Katzmarzyk, P.T., Craig, C.L., ＆Bouchard, C. (2001). Original article underweight, overweight and obesity：Relationships with mortality in 13-year follow-up of the Canada Fitness Survey. Journal of Clinical Epidemiology, 54(9), 916-920.
Karlsson, J., Sjostrom, L., ＆ Sullivan, M.(1998). Swedish obese subjects(SOS): An interventional study of obesity. Two year follow-up of health-related quality of life (HRQL) and eating behavior after gastric surgery for severe obesity. International Journal of Obesity, 22, 113-126.
Klain, J., Fraser, D., Goldstein, J., Peiser, J., Avinoah, E., Ovnat, A., & Charuzi, I. (1989). Liver history abnormalities in the morbidly obese. Hepatology, 10(5), 873-876.
Lu, R. J. F., Tseng, H.M., Gandek, B., & Ware, J.E. (2000). Development and pscyhometric testing of the Taiwan version of the SF-36 health survey.
MacDonald, K.G., Long, S.D., ＆ Swanson, M.S. (1997). The gastric bypass operation reduces the progression and mortality of non-insulin dependent diabetes mellitus. Journal of Gastrointestinal Surgery, 1, 213-220.
MacKeigan, L. D., ＆ Pathak, D. S. (1992). Overview of health related quality of life measures. American Journal Hospital Pharmacy, 49, 2236-2245.
Manson, J. E., Willett, W. C., Stampfer, M. J., Colditz, G. A., ＆ Hunter, D.J. (1995) Body weight and mortality among women. New England Journal Medicine, 333, 677-685.
Meeberg, G. A. (1993). Quality of life: A concept analysis. Journal of Advanced Nursing, 18(1), 32-38.
Melodie, K. Moorehead., Elisabeth Ardelt-Gattinger., Hans Lechner. (2003). The validation of the Moorehead-Ardelt Quality of Life questionnaire II. Obesity Surgery, 13, 684-692.
NIH. (1991). Conference: Gastrointestinal surgery for severe obesity. Annals Internal Medicine, 115, 959-961.
Ota, T., Takamura, T., Hirai, N., ＆ Kobayashi, K. (2002). Preobesity in World Health Organization classification involves the metabolic syndrome in Japanese. American Diabetes Association, 25(7), 1252-1253.
Potteiger, C.E., Paragi, P.R., ＆ Inverso, N.A. (2004). Bariatric Surgery: Shedding the Monetary Weight of Prescription Costs in the Managed Care Arena. Obesity Surgery, 14, 725-730.
Read, J. L. (1993). The new era of quality of life assessment. In S. R. Walker & R. M. Rosser (Eds.). Quality of life assessment: Key issues in the1990s. etherlands: Kluwer Academic.
Sahyoun, N. R., Hochberg, M. C., Helmick, C. G., Harris, T., ＆ Pamuk, E.R. (1999). Body mass index, weight change, and incidence of self-reported physician-diagnosed arthritis among women. American Journal of Public Health, 89(3), 391-394.
Seidell, J. C., Visscher, T. L., ＆ Hoogeveen, R. T. (1999). Overweight and obesity in the mortality rate date：Current evidence and research issues. Medicine ＆ Science in Sports ＆ Exercise, 31(11), 597-601.
SPSS, Inc. (2000). SPSS Base 10.0 applcations guide. Chicago, IL: SPSS Inc.
Stewart, A.L., ＆ Brook, R.H. (1983). Effects of being overweight. American Journal of Public Health, 73, 171–178.
Sullivan, M., Karlsson, J., ＆ Ware, J.E. (1995). The Swedish SF-36 health survey – I. Evaluation of data quality, scaling assumptions, reliability and construct validity across general populations in Sweden. Social Science & Medicine, 41, 1349-58.
Sullivan, M., Karlsson, J., ＆ Sjostrom, L. (1993). Swedish obese subjects (SOS): an intervention study of obesity. Baseline evaluation of health and psychological functioning in the first 1743 subjects examined. International Journal of Obesity, 17, 503–512.
Symmons, D. P., Bankhead, C. R., Harrison, B. J., Brennan, P., Barrett, E. M., Scott, D. G., ＆ Silman, A. J. (1997). Blood transfusion, smoking, and obesity as risk factors for the development of rheumatoid arthritis：results form a primary carebased incident case-control study in Norfolk, England. Arthritis ＆ Rheumatism, 40(11), 1955-1961.
The WHOQOL Group. (1998). Development of World Health Organization WHOQOL-BREF quality of life assessment. Psychological Medicine, 28(3), 551-558.
Ware, J. E., & Sherbourne, C.D. (1992). “The MOS 36-Item Short-Form Health Survey (SF-36).I. Conceptual framework and item selection.” Medical Care, 30, 473-483.
Ware, J. E., Snow, K.K., Kosinski, M., ＆ Gandek, B. (1993). SF-36 Health Survey and Interpretation Guide. Boston: The Health institute, New England Medical Center Hospitals.
Ware JE., Kosinski M., ＆ Keller SD. (1994). SF-36 Physical and Mental Health Summary Scales: A User’s Manual(p.6), Boston, MA: The Health Institute.
Weinberger, M. (1996) Are health-related quality of life measures affected by the mode of administration? Journal of Clinical Epidemiology, 49(2), 135-140.
Wolinsky, F.D., ＆ Timothy, E. S. (1996). A Measurement model of the medical outcomes study 36-item short-form health survey in a clinical sample of disadvantage, older, black, and white men and women. Medical Care, 34, 537-548.