臺灣博碩士論文加值系統

摘 要
本研究旨在探討裝置心律去顫器病人之憂鬱與生活品質情形，採質量性綜合研究設計，同時以質性、量性研究方法進行資料收集，分析裝置心律去顫器病人裝置前、裝置後三個月、裝置後六個月及裝置後十二個月的生活品質及憂鬱程度狀況。採方便取樣，於民國102年1月至9月，使用SF-36生活品質量表及BDI-Ⅱ憂鬱量表，於北部某醫學中心心臟內科門診及病房收案，共收案62名。將所得資料以SPSS 20.0 套裝軟體進行統計分析，以t-test、one way ANOVA、Pearson's correlation、Kruskal-Wallis test 、Wilcoxon Rank Sum來呈現各變項間的相關及差異，並輔以質性內容分析來呈現。
本研究結果發現：(1)裝置心律去顫器病人於生活品質得分，最高的項目為「身體疼痛」66.58分，標準差為25.37分，且有顯著差異(p=0.041)；生活品質得分最低的項目為「生理-角色」33.47分，標準差為39.19分，有顯著差異(p=0.041)。由裝置時間來看，裝置後三個月生活品質得分最低，為49.1分，標準差為16.6分；置後十二個月生活品質得分最高，為60.4分，標準差為18.4分；在基本屬性中，裝置前有工作者其生活品質明顯較佳，呈顯著差異。(2)裝置心律去顫器病人於憂鬱量表總分，得分最高的項目為「失去對性方面的興趣」；以裝置後三個月憂鬱程度得分最高，為15.2分，標準差為9.3分，屬輕度憂鬱；裝置前憂鬱程度得分最低，為9.7分，標準差為8.6分。(3)裝置心律去顫器病人之憂鬱與生活品質呈顯著負相關(r=-0.83，p<0.001)；即裝置心律去顫器病人生活品質分數越高，憂鬱程度越低。
本研究結果可協助健康專業人員，對於裝置心律去顫器病人之憂鬱與生活品質，有更進一步的了解，進而提供合宜的照護活動。建議臨床健康照護者，不僅應關注心律去顫器所帶來病人生命延長的效益，還需注意病人接受心律去顫器後的生活適應以及心理調適。
關鍵字：心律去顫器、生活品質、憂鬱、質量性研究

ABSTRACT
This study is aimed to investigate depression and quality of life of patient who uses implantable cardioverter-defibrillator (ICD). Mixed method with triangulation design was applied in this study. Quantitative as well as qualitative method were used to collect data and analyze the depression and quality of life for patients 3 months before ICD implantation, 3, 6 and 12 months after implantation.By convenient sampling, SF-36 quality of life scale and BDI-ⅡDepression Scale were utilized for data collection at cardiac clinic or ward in a medical center in northern Taiwan from January to September 2013. Totally 62 patients were recruited. All statistical analyses were performed with the use of SPSS 20.0 to conduct t-test, one way ANOVA, Pearson's correlation, Kruskal-Wallis test and Wilcoxon Rank Sum to check association and difference in each variable, supplemented by qualitative data analysis.
The results of the study showed: (1) the highest quality of life score among patients with ICD is "bodily pain, BP" (66.58 ± 25.37, p = 0.041); the lowest is " role limitation due to physical problems,RP“ (33.47 ± 39.19 points, p = 0.041). From time scale, the lowest quality of life score is 3 months after ICD implantation (49.1 ± 16.6); the highest is 12 months after implantation (60.4 ± 18.4). Among basic properties, the patients with work before implantation have a significantly better quality of life. (2) The highest depression score is "loss of interest in sex". From time scale, the highest score is 3 months after ICD implantation (15.2 ± 9.3), which is a mild depression; the lowest is before ICD implantation (9.7 ± 8.6). (3) The depression and quality of life of patients showed a significant negative correlation (r = -0.83, p <0.001), suggesting the higher score of quality of life, the lower depression of patient with ICD.
The results of this study can help health professionals to have better understanding of depression and quality of life among patients with ICD and therefore provide more appropriate health care.
Health care providers should not only concerned the benefit of ICD that prolongs patients’ life but also pay more attention to life adaptation and psychological adjustment after ICD implantation.

Key words: implantable cardioverter-defibrillator (ICD)、quality of life、depression、mix method triangulation

目　　次

第一章 緒論
第一節研究背景與動機…………………………………………………………………….........1
第二節研究目的………………………………………………………………………………....... 4
第三節研究問題………………………………………………………………………………....... 4
第四節名詞解釋………………………………………………………………………………....... 4
第二章 文獻探討
第一節植入型心率去顫器簡介…………………………………………………………...........6
第二節病人裝置植入型心率去顫器之經驗相關研究………………………................. 10
第三節裝置植入型心率去顫器病人生活品質之相關研究…………………................. 12
第四節裝置植入型心率去顫器病人憂鬱之相關研究………………………................. 17
第三章 研究方法
第一節研究設計…………………………………………………………………………………..... 20
第二節研究對象…………………………………………………………………………………..... 21
第三節研究場所…………………………………………………………………………………..... 21
第四節研究工具………………………………………………………………………………....... 22
第五節資料收集過程……………………………………………………………………….........26
第六節資料分析方法……………………………………………………………………….........27
第七節研究倫理………………………………………………………………………………....... 32
第四章 研究結果
第一節裝置植入型心率去顫器病人之基本屬性………………………………................33
第二節裝置植入型心率去顫器病人之生活品質………………………………................35
第三節裝置植入型心率去顫器病人憂鬱程度.…………………………………...............47
第四節裝置植入型心率去顫器病人生活品質與憂鬱程度………………................... 51
第五節裝置植入型心率去顫器病人生活品質與憂鬱程度之相關性.......................52
第五章 討論
第一節裝置植入型心率去顫器病人裝置前後之生活品質………………....................53
第二節基本屬性與疾病特性及生活品質的關係………………………………................55
第三節裝置植入型心率去顫器病人裝置前後憂鬱程度…………………................... 58
第四節基本屬性與疾病特性及憂鬱程度的關係………………………………................60
第五節裝置植入型心率去顫器病人生活品質與憂鬱之相關性………..................... 62
第六章 結論與建議
第一節結論............................................................... 63
第二節應用與建議..........................................................64
第三節研究限制 ........................................................66
參考文獻
中文部分………………………………………………………………………………………………..67
外文部分………………………………………………………………………………………………… 70
附錄
附錄一訪談說明同意書………………………………………………………………………....... 79
附錄二受訪者基本資料………………………………………………………………………....... 84
附錄三SF-36生活品質量表………………………………………………………………......... 85
附錄四訪談指引……………………………………………………………………………………....89


圖表目次
表3-1 研究工具之資料分析方法.............................................30
表4-1 裝置心律去顫器病人之基本資料........................................34
表4-2-1 生活品質及其個範疇得分.............................................36
表4-2-2 生活品質量表之單題得分情形..........................................37
表4-2-3 生活品質及其個範疇於四個組別得分比較.................................38
表4-2-4 裝置心律去顫器後影響生活品質之內涵─身體疼痛...........................39
表4-2-5 裝置心律去顫器後影響生活品質之內涵─生理-角色..........................40
表4-2-6 裝置心律去顫器後影響生活品質之內涵─心理健康狀況之負向經驗...............42
表4-2-7 裝置心律去顫器後影響生活品質之內涵─心理健康狀況之正向經驗...............44
表4-2-8 個人基本屬性與生活品質總分之比較.....................................46
表4-3-1 裝置心律去顫器病人憂鬱量表之平均得分與次數分佈情形.....................48
表4-3-2 裝置心律去顫器病人憂鬱量表各題的選項與平均得分分佈情形..................48
表4-3-3 BDI總分於四個組別得分比較...........................................49
表4-3-4 個人基本屬性與憂鬱程度總分之比較......................................50
圖4-1 生活品質與憂鬱量表分數分布於四組研究對象之比較..........................51
圖4-2 生活品質分數與憂鬱量表分數散佈圖......................................52

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