臺灣博碩士論文加值系統

口乾在透析病患是具高發生率之症狀困擾，口乾症狀若未緩解將影響口腔健康及其生活品質。本研究目的旨在探討漱口護理對改善透析病患口乾、未刺激唾液流量與口乾相關生活品質之成效。採實驗性設計，於桃園地區三所透析中心，共有122位血液透析病患參與此研究，將個案隨機分派至實驗組Ι（蒸餾水漱口組; n = 41）、實驗組Ⅱ（甘草液漱口組; n = 44）與對照組(常規照護組; n = 37)。研究工具包括短型口乾量表（Xerostomia Inventory）、口乾相關生活品質量表(Xerostomia-related quality of life scale)、醫院焦慮憂鬱量表(Hospital Anxiety and Depression Scale)及收集未刺激唾液流量(Unstimulated whole saliva flow rate)，並在三個時間點進行測量(前測; 第五天與第十天)。調控前測達顯著差異的變項，以廣義估計方程式(GEE; Generalized Estimating Equations)進行比較，研究結果發現，實驗組Ι在第五天、第十天與對照組相較，未刺激唾液流量增加25.85*10-3mL/min與25.78*10-3mL/min達顯著差異(p<.05)，口乾與口乾相關生活品質與對照組比較未達顯著差異；在第五天與第十天兩個時間點，實驗組Ⅱ相較於對照組其口乾、唾液流量與口乾相關生活品質皆顯著改善，且達顯著差異(p<.001)。差異對比(difference contrast)是比較實驗組Ⅱ與實驗組Ι的介入成效。實驗組Ⅱ的口乾量表得分下降3.11分，唾液流量增加68.03*10-3 mL/min，口乾相關生活品質下降3.96分，顯示甘草漱口護理優於蒸餾水(p<.001)。本研究結果提供一項協助緩解透析病患口乾症狀實證之護理措施，透析病患出現口乾症狀時使用甘草漱口液則緩解口乾不適，增加唾液流量及提升口乾相關生活品質的成效更佳。

Dry mouth is a high incidence symptom in hemodialysis patients. Dry mouth affects patient oral health and quality of life. The purpose of this study was to examine the effectiveness of an intervention program for improving xerostomia, saliva flow rates and the xerostomia related quality of life for hemodialysis patients. Experimental design was used in this study. Overall, 122 hemodialysis patients were recruited from 3 hemodialysis centers in Tao-Yuan, Taiwan. Patients who met the criteria were randomly assigned to 3 groups: Experimental Group Ι (who gargled distilled water; n = 41), Experimental Group Ⅱ (who gargled licorice water; n = 44), and the control group (who received routine care; n = 37). The Xerostomia Inventory, Xerostomia related Quality of Life Scale, and Hospital Anxiety and Depression Scale were used for data collection at 3 time points (i.e., baseline, and Days 5 and 10 after baseline). Moreover, unstimulated whole saliva flow rate was also collected at the same 3 time points. After controlling significantly different variables among groups at baseline, the generalized estimating equation (GEE) was used to analyze the data. At Days 5 and 10, the results revealed that Experimental Group I exhibited an unstimulated whole saliva flow rate increase of 25.85*10-3 mL/min and 25.78*10-3 mL/min (p < .05), respectively; however, the mean scores of Experimental Group I on the Xerostomia Inventory and Xerostomia related Quality of Life Scale did not decrease significantly compared with those of the control group. Regarding Experimental Group II, the unstimulated whole saliva flow rates and scores on the Xerostomia Inventory and Xerostomia related Quality of Life Scale improved compared with those of the control group at Days 5 and 10 (p <.001). Then, a contrast analysis was performed to compare the effectiveness of Experimental Group II with Experimental Group I. Results revealed that the sore on the Xerostomia Inventory was reduced to 3.11, the unstimulated whole saliva flow rate increased to 68.03*10-3 mL/min, and the score on the Xerostomia related Quality of Life Scale was lowered to 3.96 in patients who were Experimental Group II. The results also indicated that the effectiveness of the licorice water gargle was superior to that of the distilled water gargle (p < .001). Our results provide an evidence-based nursing intervention method for relieving xerostomia, increasing the unstimulated whole saliva flow rate, and enhancing the xerostomia related quality of life in hemodialysis patients who use licorice water to gargle.

目 錄
長庚大學博碩士學位論文指導教授推薦書………………………
長庚大學博碩士學位論文口試委員會審定書……………………
長庚大學博碩士論文著作授權書………………………………… 
致謝 ……………………………………………………………… iv
中文摘要 ………………………………………………………… v
英文摘要 ………………………………………………………… vii
目錄 ……………………………………………………………… ix
表次目錄…………………………………………………………… xii
圖次目錄…………………………………………………………… xiv
第一章 緒論
第一節 研究背景與動機 ……………………………………… 1
第二節 研究目的 ……………………………………………… 4
第三節 名詞界定 ……………………………………………… 4
第二章 文獻查證
第一節 口乾…………………………………………………… 6
第二節 唾液與口乾生理機制………………………………… 13
第三節 影響口乾的因素……………………………………… 17
第四節 透析病患口乾之相關研究…………………………… 21
第五節 口乾相關生活品質之研究…………………………… 24
第六節 減緩口乾之介入措施………………………………… 25
第七節 甘草療效與臨床應用………………………………… 29
第三章 研究方法
第一節 研究架構……………………………………………… 37
第二節 研究假設……………………………………………… 39
第三節 研究設計……………………………………………… 39
第四節 研究對象與地點……………………………………… 40
第五節 樣本數估計…………………………………………… 41
第六節 研究工具……………………………………………… 41
第七節 資料收集步驟………………………………………… 49
第八節 介入性措施…………………………………………… 53
第九節 研究倫理……………………………………………… 56
第十節 資料分析……………………………………………… 57
第十一節 先驅研究結果分析 ………………………………… 58
第四章 研究結果
第一節 研究對象基本屬性…………………………………… 70
第二節 研究對象之前測結果………………………………… 78
第三節 介入措施之成效……………………………………… 89
第五章 討論
第一節 研究對象參與率……………………………………… 101
第二節 研究對象基本屬性…………………………………… 102
第三節 前測(Baseline)各變項之分析………………………… 104
第四節 介入措施之成效……………………………………… 113
第六章 結論與建議
第一節 結論…………………………………………………… 117
第二節 護理應用……………………………………………… 119
第三節 研究限制……………………………………………… 119
第四節 未來研究之建議……………………………………… 121
參考文獻
中文部分 ……………………………………………………… 123
英文部分 ……………………………………………………… 127

附錄
附錄一 基本資料問卷………………………………………… 139
附錄二 口乾視覺量表（VAS）……………………………… 141
附錄三 口乾量表……………………………………………… 142
附錄四 口乾相關生活量表…………………………………… 143
附錄五 醫院焦慮及憂鬱量表………………………………… 145
附錄六 口腔清潔習慣問卷…………………………………… 148
附錄七 口腔評估量表………………………………………… 151
附錄八 漱口護理衛教單張…………………………………… 152
附錄九 口腔清潔自我監測表………………………………… 153
附錄十　甘草漱口液使用注意事項…………………………… 154
附錄十一 口乾量表同意書…………………………………… 155
附錄十二 口乾相關生活品質量表同意書…………………… 156
附錄十三 口腔清潔問卷同意書……………………………… 157
附錄十四 醫院焦慮及憂鬱量表—中文版同意書…………… 158
附件十五 醫院焦慮及憂鬱量表憑証………………………… 159




表次目
表2.1 口乾主觀感覺的測量方式……………………………… 10
表3.1 研究測量時間點………………………………………… 40
表3.2 各透析中心時段之組別………………………………… 40
表3.3 各測量時間所使用之研究工具………………………… 57
表3.4 統計方法………………………………………………… 58
表3.5 先驅測試之基本資料…………………………………… 60
表3.6 先驅測試之臨床檢驗值………………………………… 61
表3.7 唾液流量與檢驗值之關係……………………………… 64
表3.8 口乾表與口乾相關生活品質之平均值………………… 64
表3.9 口乾量表、唾液流量與口乾相關生活品質之相關性… 65
表3.10 口乾視覺量表平均值…………………………………… 65
表3.11 口腔評估結果…………………………………………… 65
表3.12 收集資料面臨之困難與修正方向……………………… 67
表4.1 整體與不同組別研究對象之基本屬性………………… 74
表4.2 研究對象之口腔清潔習慣……………………………… 76
表4.3 研究對象之臨床生理檢驗值…………………………… 80
表4.4 口乾視覺量表與口腔評估(前測) ……………………… 83
表4.5 口乾視覺量表與口腔健康關係………………………… 84
表4.6 研究對象心理狀態與口乾、唾液流量、口乾相關生活品質之分布 …………………………………………… 88
表4.7 口乾相關生活品質各層面之得分及排序……………… 89
表4.8 GEE參數估計表--口乾量表總分……………………… 91
表4.9 GEE參數估計表--唾液流量…………………………… 93
表4.10 GEE參數估計表--口乾相關生活品質……………… 95
表4.11 GEE差異對比(difference contrast)檢定摘要表 …… 96
表4.12 GEE參數估計表--口乾相關生活品質—生理……… 97
表4.13 GEE參數估計表--口乾相關生活品質—個人……… 98
表4.14 GEE參數估計表--口乾相關生活品質—社會……… 99
表4.15 GEE參數估計表--口乾相關生活品質—疼痛……… 100

圖次目錄
圖2.1 甘草次酸與腎上腺皮質醇化學結構式………………… 33
圖3.1 透析病患口乾、唾液流量及口乾相關生活品質之關係 38
圖3.2 資料收集流程圖………………………………………… 51
圖3.3 研究測量流程圖………………………………………… 52
圖3.4 實驗組接受介入措施之流程…………………………… 55
圖3.5 唾液收集………………………………………………… 63
圖3.6 每分鐘唾液流量………………………………………… 63
圖3.7 口腔評估………………………………………………… 66
圖3.8 甘草漱口液四種濃度使用後之唾液流量……………… 69
圖4.1 資料收集結果與各組參與人數………………………… 71
圖4.2 唾液流量與口乾、口乾相關生活品質散佈圖………… 87
圖4.3 三個時間點各組口乾總分之變化趨勢………………… 91
圖4.4 三個時間點各組唾液流量之變化趨勢………………… 93
圖4.5 二個時間點各組口乾相關生活品質之變化趨勢……… 95
圖4.6 二個時間點各組口乾相關生活品質—生理之變化趨勢 97
圖4.7 二個時間點各組口乾相關生活品質—個人之變化趨勢 98
圖4.8 二個時間點各組口乾相關生活品質—社會之變化趨勢 99
圖4.9 二個時間點各組口乾相關生活品質—疼痛之變化趨勢 100

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