臺灣博碩士論文加值系統

便秘是住院老人常見的臨床問題。除主要疾病外，由於老化產生生理變化，如咀嚼能力減弱而使飲食習慣改變，以及慢性病所衍生出身體活動功能限制等問題，均使住院老人較容易發生便秘。然而，醫護人員常未仔細評估真正導致病患發生便秘的因素即直接給予瀉劑來改善，如此單靠服用藥物的方式，非但不能徹底解決便秘問題，反而浪費醫療資源。然而查閱我國的文獻，卻少有人探究。因此，本研究目的是探討住院老人人口學變項、健康狀況及住院期間經歷的便秘危險因子，與臨床客觀判斷便秘間的關係，並調查住院老人使用瀉劑的狀況。
本研究採縱貫式觀察，便利取樣，在台北市某家醫學中心六個老人便秘盛行率高的內外科病房以「入院前排便狀況調查表」選出65歲(含)以上符合收案條件的老人，於住院後第四天及發生便秘時依「住院期間排便狀況調查表（II）-危險因素」蒐集資料，之後每天按照「住院期間排便狀況調查表（I）」蒐集排便狀況；當老人開始使用瀉劑則改以「住院期間排便狀況調查表（III）-處理與結果」追蹤個案用藥處理結果。
本研究重要發現歸納如下：
1. 本研究共收152位老人，其中住院期間有發生便秘者共50位：三天以上未解便者有38位( 25.0 % )，而解硬便者有12位( 7.9 % )；無便秘症狀者共102位。另外不符合收案條件者有58位。
2. 迴歸模式結果為食物纖維量少於6公克(含)的個案，發生便秘機率是多於6公克個案的6.21倍( 95 % 信賴區間為1.97-19.63 )；完全臥床的個案，發生便秘機率是可獨立活動者的3.47倍( 95 % 信賴區間為1.44-8.35 )；未使用含鋁和鎂鹽類的Antacid藥物是使用者3.60倍( 95 % 信賴區間為1.52-8.54 )。而其它如：性別、年齡、疾病診斷個數和類別、攝水量、非瀉劑藥物種類及使用致便秘的藥物等變項，皆未達統計上的差異。其中便秘者傾向年齡較大和未使用NSAIDs藥物，但控制其它相關因素後便不顯著。
3. 住院期間使用最多的瀉劑為MgO( 46.7 % )，其次為Bisacodyl (Dulcolaxa)塞劑( 31.6 % )。有66位是未發生便秘即開始給予口服瀉劑，但其中有18位( 37.3 % )在使用瀉劑後仍發生便秘，先使用瀉劑無法完全預防便秘發生。
4. 分析95位使用瀉劑的個案，結果有29位( 30.5 % )是使用瀉劑後發生腹瀉；有7位( 7.7 % )發生大便失禁，使用瀉劑與腹瀉及大便失禁有關( p = .016，p = .038 )，使用瀉劑的個案中，發生腹瀉及大便失禁的比率較高。
5. 比較符合與不符合收案條件個案的基本資料，有慢性便秘傾向者以疾病診斷個數、罹患帕金森氏症及糖尿病較多；而兩組個案的年齡、性別和教育程度等基本特性皆無統計上的差異。
綜合歸納結果，無便秘史的老人於住院後有三分之一會發生便秘，特別是食物纖維攝取量少於6公克(含)和完全臥床的老人容易發生，然而未便秘時給予口服瀉劑並無法完全預防便秘發生，且老人使用瀉劑會增加腹瀉和大便失禁的比率。透過本研究結果，可幫助護理人員對住院老人便秘問題有更深入的瞭解，且能事先篩選發生便秘的高危險群，給予妥善預防和適當處置，發揮護理獨特功能，以增進老人生活品質並減少醫療資源浪費。

Constipation is a common problem among elderly patients in hospital. Old age produces physiological changes, such as the decreased ability to chew, that lead to an alteration in dietary habits, and chronic illnesses that cause a limitation in physical activity. These factors put the elderly at risk of becoming constipated. Health care workers often prescribe laxatives without assessing the causes of constipation. Using laxatives in this way does not only fail to solve the constipation problem, but is also a waste of medical resources. References on this topic suggest investigation related to constipation has been relatively sparse in Taiwan. Hence, the objectives of this study were: (1) To investigate the relationships between, demographic characteristics, health status, risk factors and the occurrence of constipation; (2) To investigate the use of laxatives in the hospitalized elderly.
This was a longitudinal study that investigated people aged 65 years and over, who had had no chronic constipation within three months before admission in six wards of a tertiary medical center in Taipei. Subjects were investigated using 4 questionnaires composed by the researcher. First, subjects were selected using "The questionnaire of pre-admission bowel movements". On the 4th day of admission or upon the occurrence of constipation, the researcher collected data using "The survey of bowel movements during hospitalization II - risk factors". Data was then collected everyday using "The survey of bowel movements during hospitalization I". When the subjects received laxatives, their data were collected everyday using "The survey of bowel movements during hospitalization III - management and outcome".
The results of this study showed that:
1. Fifty subjects (33%) of the 152 respondents had constipation during hospitalization, 38 subjects (25.0%) did not have a bowel movement for more than 3 days, and 12 subjects (7.9%) passed hard stools. One hundred and two subjects did not have constipation.
2. A stepwise logistic regression model showed that the hospitalized elderly who consumed 6g or less of dietary fiber were 6.21 times more likely to develop constipation than those who consumed more than 6g of dietary fiber (95% CI 1.97 to 19.63). Bedridden elderly were 3.47 times more likely to suffer from constipation than those who ambulated independently (95% CI 1.44 to 8.35). Elderly who did not receive antacid which contained aluminum and magnesium were 3.60 times more likely to develop constipation than those who did (95% CI 1.52 to 8.54). Other variables, for example; sex, age, number and category of diseases, fluid intake, non-laxatives drugs, constipation inducing drugs and so on were not shown to be statistically significant. Although older patients and patients who did not use NSAIDs tended to have constipation, the tendency did not prove to be statistically significant.
3. During hospitalization, MgO (46.7%) was most commonly administered, followed by Bisacodyl suppositories (31.6%). Sixty-six subjects received prophylactic laxatives, but among them 18 still suffered from constipation. Prophylactic laxatives did not completely prevent the occurrence of constipation in the subjects who received them.
4. Of the 95 subjects who received laxatives, results showed that 29 subjects (30.5%) had diarrhea and 7 subjects (7.7%) had fecal incontinence. The relationship between subjects who had diarrhea and fecal incontinence and the use of laxatives was statistically significant (p=0.016, p=0.038). Subjects who received laxatives had a higher tendency to develop diarrhea and fecal incontinence.
5. During the subject recruitment, 58 patients were excluded because they did not meet selection criteria. By comparing the baseline variables of the respondents who met the selection criteria with those who did not, the results showed that subjects who experienced chronic constipation tended to have a greater number of diseases and were more often diagnosed to have Parkinsonism and diabetes mellitus. There were no statistical differences between age, sex, and education in either group.
The results revealed that about one third of the elderly patients who did not have a history of constipation prior to hospitalization developed constipation in hospital. Elderly patients who consumed less than 6g of dietary fiber and who were bedridden had a greater tendency to develop constipation. Prophylactic laxatives did not completely prevent the occurrence of constipation and the use of laxatives increased the tendency to develop diarrhea and fecal incontinence. The findings of this study may help nurses to; understand the problem of constipation among the hospitalized elderly, screen and detect the high-risk groups early to prevent the occurrence of constipation, provide appropriate intervention and implement professional nursing in order to increase the quality of life among elderly patients, and reduce the waste of medical resources.

目 錄 頁數
致謝 i
中文摘要 ii
英文摘要 iv
內容目錄 vii
圖表目次 ix
第一章 緒論
第一節 研究的重要性 1
第二節 研究動機與目的 3
第三節 研究問題 4
笫二章 文獻查證
第一節 便秘的定義與診斷 5
第二節 排便機轉 8
笫三節 正常老化過程及便秘老人的下腸道功能變化 9
第四節 影響住院老人便秘的危險因素 11
第五節 瀉劑處理的方法與結果 17
第三章 研究架構與假設
第一節 研究架構 19
第二節 研究假設 20
第三節 名詞界定 21
第四章 研究方法
第一節 研究設計與對象 22
第二節 研究工具 23
第三節 研究工具的信度與效度檢定 26
第四節 資料蒐集 28
第五節 資料分析 31
第五章 研究結果
第一節 個案之基本資料 32
第二節 個案住院期間的排便狀況 33
第三節 影響住院老人發生便秘的相關因素 35
第四節 影響住院老人發生便秘的多變項危險因素 38
第五節 住院期間使用瀉劑的現況分析 40
第六節 符合與不符合收案條件個案之比較 43
第六章 討論
第一節 老人在住院期間的排便狀況 61
第二節 影響住院老人發生便秘的危險因素 63
第三節 住院老人使用瀉劑的狀況 68
第四節 符合與不符合收案條件個案之比較 70
第七章 結論與建議
第一節 結論 71
第二節 護理上的應用 73
第三節 研究限制與建議 76
參考文獻
中文文獻 78
英文文獻 79
附錄
附錄一：調查表 87
附錄二：飲食纖維量表 93
附錄三：問卷專家效度名單 94
附錄四：問卷專家內容效度檢定結果 95
附錄五：同意書 96
圖表目次 頁數
圖 3-1 影響住院老人發生便秘的危險因素與瀉劑處置 19
圖 4-1 資料蒐集流程圖 30
圖 5-1 住院期間協助個案排便所使用方法之分佈圖 60
表 5-1 個案基本資料 45
表 5-2 個案住院期間糞便重量 46
表 5-3 個案住院期間糞便性質 46
表 5-4 影響住院老人發生便秘的相關因素 47
表 5-5 個案使用與發生便秘相關之藥物名稱 49
表 5-6 影響住院老人發生便秘的多變項因素參考組 50
表 5-7 影響住院老人發生便秘的多變項因素分析 51
表 5-8 Stepwise logistic regression 分析住院老人發生便秘危險因素52
表 5-9 未發生便秘與發生便秘後使用瀉劑的狀況 53
表 5-10 未發生便秘即使用瀉劑與住院後便秘的關係 54
表 5-11 使用瀉劑後仍發生便秘的相關因素分佈情形 55
表 5-12 個案住院後使用瀉劑與腹瀉及大便失禁的關係 57
表 5-13 入院前三個月排便狀況 58
表 5-14 符合與不符合收案條件個案基本資料之比較 59

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