臺灣博碩士論文加值系統

本研究目的為探討接受PCI患者於接受治療後健康生活型態（抽菸、飲酒、運動、飲食、壓力處理及服藥遵從行為）現況及其相關的影響因素。採橫斷式相關性研究，自民國92年10月至92年12月，以便利取樣方式於台南市某所醫學中心，邀請63位3-18個月前初次接受PCI治療患者參與研究，藉由結構式問卷訪談收集資料，並以SPSS 10.0統計軟體進行描述性及推論性統計資料分析。
結果顯示患者之抽菸、飲酒及規律運動所佔比率分別為17.5 %、15.9 %及61.9 %。僅3人反而加重抽菸量，10人持續原本之飲酒習慣，但僅5人每次飲酒酒精量超過30公克。平均運動量為12.78 METs（SD = 13.26），性別及社會支持程度為規律運動之預測變項，男性執行規律運動為女性之 8.42倍；而社會支持程度高者執行規律運動為低者之1.11倍。患者飲食行為的單項總平均為3.84（SD = 1.07），代表飲食行為執行傾向經常如此做，教育及社會支持程度為飲食的預測變項，共可解釋32 %的變異量。壓力處理行為的單項總平均得分為3.09（SD = 1.23）分，代表壓力處理執行傾向有時如此做，心臟病家族史及社會支持程度為壓力處理之預測變項，共可解釋43 %的變異量。服藥遵從行為單項總平均得分為4.63（SD = 0.88）分，表示大部分患者在此項行為上偏向遵從，其與職業( p＜.05 )有顯著差異，與年齡(Spearman’s r = .27, p＜.05 ) 有顯著相關。
研究結果顯示針對本研究之冠心症患者，整體而言宜再加強運動與壓力處理之指導。針對少數抽菸行為無法改進者，極可能併有疾病與社會資源等特殊需求，宜與關注。服藥遵從行為雖傾極高之遵從度，但因個案對藥效與副作用之不解，所引發長期服藥過程中可能出現的中斷危機，需進一步評估探討。由於每項行為，其相關影響因素皆不單純，且極具個別性，故針對需進行PCI治療之患者，未來實需建立一套系統性之衛教計劃，並由專科護理師或專門個案管理人員，執行整體性之照護與追蹤，以確保PCI之醫療成效。

The purpose of the study was to investigate the healthy lifestyle (smoking, drinking, exercising, eating, stress managing, and medication taking habits) and its related factors among patients with the coronary artery disease (CAD ) receiving percutaneous coronary intervention ( PCI ). Cross sectional correlational design was used in this study. Convenient sampling had been conducted to recruit 63 subjects who have received an initial PCI 3 to 18 months ago from one of the medical center at Tainan from October to December, 2003. Structured questionnaires and face to face interview had been used to collect the data. By using SPSS/PC software version 10.0, both descriptive and inferential statistics were applied to analyze the data.
The results showed that the percentage of subjects’ smoking, drinking, and regular exercising were 17.5 %, 15.9 %, and 61.9 %, respectively. Only 3 persons increased tobacco. There were10 persons maintained the drinking habit after PCI, yet only 5 persons drink more than 30 gm of alcohol per time. The average exercise intensity was 12.78 METs ( SD = 13.26 ). The result of the analysis of logistic regression indicated that the predicting factors of regular exercise were gender and social support, and the odds ratios were 10.8 and 1.11, respectively. The averaged score of dietary behaviors was 3.84 ( SD = 1.07 ). Based on the analysis of multiple regression, the results showed that education and social support were the predictors of dietary behaviors. These two factors accounted for 32 % of the variation in dietary behaviors. The average score of stress management was 3.09 ( SD = 1.23 ). The results of multiple regression analysis indicated that family history of heart diseases and social support were the two significant predictors of stress management behaviors. These two factors accounted for 43 % of the variation in stress management. The average score of medication taking behaviors was 4.63 ( SD = 0.88 ), means subjects had high level of compliance in medication taking behaviors. Medication taking was significant difference to occupation ( p＜.05 ) and positively related to age (Spearman’s r = .27, p＜.05 ).
The findings of this study suggest that the subjects need more instructions in regular exercise and stress management. For those subjects who didn’t improve their smoking behavior need more considerations in their deterioration of physical condition and lack of social support. Although the patients showed highly compliance in their medication taking behaviors, we can’t neglect the possible long-term episodes of incompliance behaviors because of patients’ ignorance of the purposes and the side effects of their medications. Finally, because each healthy behavior investigated in this study have been revealed to have multiple influencing factors, in clinics, we do need to establish a comprehensive education program for them. Furthermore, a clinical nursing specialist or a case manger will be needed to fulfill the individualized and continuous needs of the patients under PCI. Then, the success of the PCI can be further guaranteed.

第一章 緒論 1
第一節 研究重要性與動機 1
第二節 研究目的 4

第二章 文獻查證 5
第一節 CAD患者保健相關生活型態之研究 5
第二節 CAD患者及PCI治療後健康生活型態相關影響因素 之研究 11
第三節 文獻總結 17

第三章 研究架構與研究假設 18
第一節 研究架構 18
第二節 研究假設 20

第四章 研究方法與過程 21
第一節 名詞界定 21
第二節 研究對象 22
第三節 研究工具信效度及測量方法 23
第四節 研究過程 28
第五節 資料分析 30

第五章 研究結果 35
第一節 人口學資料屬性、疾病特性分析、主觀生理症
狀、社會支持程度之分析 35
第二節 抽菸、飲酒、運動、飲食、壓力處理、及服藥遵
從行為之情形 46
第三節 健康生活型態與人口學、疾病特性、主觀生理症
狀及社會支持程度相關性分析 54
第四節 規律運動、飲食與壓力處理預測因素分析 66
第五節 結果總結 73

第六章 討論 75
第一節 人口學資料屬性 75
第二節 抽菸行為 75
第三節 飲酒行為 77
第四節 運動行為 78
第五節 飲食行為 82
第六節 壓力處理行為 85
第七節 服藥遵從行為 88

第七章 結論與建議 91
第一節 結論 91
第二節 研究結果之應用與建議 94
第三節 研究限制及未來相關研究建議 96

中文參考資料 98
英文參考資料 101

于漱（1994）•基隆市居家老人自服藥物情形及影響因素研究•公共衛生，21（2），108-117。

王保進（1999）•SPSS與無母數統計分析•視窗版SPSS與行為科學研究（pp. 649-676, 693），台北：心理出版社。

江儀輝、李篤宜、李仁忠、程俊傑（1997）•冠狀動脈氣球擴張術及血管支架法之介紹與探討•中華放射線技術學雜誌，21（1），45-49。

行政院衛生署（2003年7月14日）•台灣地區主要死因分析•台灣衛生網路•取自http://www.doh.gov.tw/lane/statist/89/900613-1.doc

行政院衛生署國民健康局（2003年12月12日）•促進健康體能的方法•台灣衛生網路•取自http://www.doh.gov.tw/ch/index.htm

李明德（1992）•老年心肌梗塞病患生活調適與相關因素之探討•未發表之碩士論文，台北：國防醫學院護理所。

李源德、朱樹醺、黃博昭、蔡忠文、王永深（1993）•台灣的冠狀動脈心臟病•台灣醫誌，92（4），S814-S819。

沈軫翔（1998）•心血管疾病生化、生理指標及生活型態之研究•未發表之碩士論文，台南：成功大學生物學所。
林秋菊、柯乃熒、蔡玲君、陳彰惠（1995）•健康信念、尿毒症認知和社會支持對慢性血液透析病人遵從行為之影響•高雄醫學科學雜誌，11，470-480。

邱慧芬、楊俊毓、陳啟佑、翁永宏、蔡尚學、林清維（2001）•高雄市社區民眾用藥之調查，行政院衛生署中央健保局委託研究成果報告•（DOH89-NH-057）。

胡文郁、曾春典、戴玉慈、余玉眉（1996）•高血壓患者服藥遵從行為及其相關因素之探討•中華衛誌，15（4），319-331。

胡文郁、戴玉慈、于博芮、余玉眉、曾春典（1999）•老年高血壓患者服藥遵從行為及其影響因素之研究•慈濟醫學，11（3），227-135。

胡雪萍（1998）•台灣地區心血管疾病患者營養的知識及態度調查研究•行政院衛生署委託研究成果報告•（DOH87-TD-1094）。

張蓉蘭（1998）•衛教方案對冠狀動脈擴張術病患危險因素監控知識、態度與行為之成效•未發表之碩士論文，桃園：長庚大學護理學研究所。

許莉玲（2003）•冠狀動脈疾病婦女疾病嚴重度、危險因子與健康相關行為之探討•未發表之碩士論文，台北：台北醫學大學。

許寬立（1996）•支架置放的技術觀•醫學繼續教育，6（2），122-126。

郭素青（1998）•某區域教學醫院門診高血壓病患服藥遵從行為及其相關因素之探討•未發表之碩士論文，高雄：中山醫學院醫學研究所。

陳夏蓮、李薇莉（2000）•重新認識高血壓•護理雜誌，47（5），64-70。

陳晶瑩（2000）•如何幫助病人戒菸•當代醫學，27（1），44-51。

曾淵如（1998）•高血壓及其併發症之診斷與處置，當代醫學，25（1），2-7。

馮觀富（1993a）．壓力何物？．研習資訊，10（3），35-41。

馮觀富（1993b）．壓力管理（一）．研習資訊，10（4），37-41。

馮觀富（1993c）．壓力管理（二）．研習資訊，10（4），44-49。

黃雅文、藍忠孚、劉貴雲、姜逸群、方進隆（1991）•中老年人健康生活型態之探討•公共衛生，18（2），133-146。

黃翠媛、施素娥、劉善欣、黃秀梨（1995）•心臟病患出院後對支持性團體需求之探討•護理雜誌，42（1），65-74。

黃璉華（1996）•社區老人用藥教育介入成效之探討•護理研究，4（2），197-207。

鍾玉珠（1995）•冠狀動脈繞道手術後患者生活調適與相關因素之探討•未發表之碩士論文，台北：國防醫學院護理學研究所。

劉秉彥、陳志鴻（2002）•冠狀動脈疾病•科學發展，352，48-53。

劉淑娟（1999）•罹患慢性病老人服藥遵從行為及其相關因素之探討•護理研究，7（6），581-593。

潘正德譯（1995）．壓力管理．台北：心理。

蔡仁貞（1996）•冠狀動脈病患疲倦感受度、運動耐力與日常活動量之探討•護理研究，4（4），312-320。

蔡仁貞（1999）•心臟病患對心臟復健工作的認知與實施需求之探討•新台北護理期刊，1（1），59-67。

鄭綺（1997）•心臟病患者居家運動指導•護理雜誌，44（1），24-29。

Ades, P. A., Huang, D., & Weaver, S. O. (1992). Cardiac rehabilitation participation predicts lower rehospitalization costs. American Heart Journal, 123(4), 916-921.

Blenkiron, P. (1996). The elderly and their medication: Understanding and compliance in a family practice. Postgraduate Medical Journal, 72(853), 671-676.

Cavender, J. B., Rogers, W. J., Fisher, L. D., Gersh, B. J., Coggin, C. J., & Myers, W. O. (1992). Effects of smoking on survival and morbidity in patients randomized to medical or surgical therapy in the Coronary Artery Surgery Study (CASS): 10-year follow up CASS investigators. Journal of the American College of Cardiology Abstract, 20(2), 287-294.

Chen, C. H. (1995). Physical exercise and sense of well-being among Chinese elderly in Taiwan. Unpublished doctoral dissertation, University of Texas, Austin.

Clark, D. A. (1991). Coronary angioplasty (2th ed., pp. 83-91). NY: Wiley-Liss.
Davidson, D., Winchester, M., Taylor, C., Alderman, E., & Ingels, N. (1979). Effects of relaxation therapy and cardiac performance and sympathetic activity in patients with organic heart disease. Psychosomatic Medicine Abstract, 41, 303-309.

Dempsey, S. J., Dracup, K., & Moser, D. K. (1995). Women’s decision to seek care for symptoms of acute myocardial infarction. Heart and Lung: Journal of Acute and Critical Care, 24(6), 444-56.

Dietz, U., Rupprecht, H. J., de Belder, M. A., Wijns, W., Quarles van Ufford, M. A., Klues, H. G., & vom Dahl, J. (2002). Angiographic analysis of the angioplasty versus rotational atherectomy for the treatment of diffuse in-stent restenosis trial. American Journal of Cardiology Abstract, 90(8), 843-847.

Eastwood, G. N. (2001). Lifestyle pattern change in males following percutaneous transluminal coronary angioplasty/intracoronary stenting. International Journal of Nursing Practice, 7(2), 131-137.

Fleetwood, C. J., & Packa, D. R. (1991). Determinants of health-promoting behaviors in adults. The Journal of Cardiovascular Nursing, 5(2), 67-79.

Fleury, J., Kimbrell, L. C., & Kruszewski, M. A. (1995). Life after a cardiac evevnt: Women’s experience in healing. Heart and Lung: Journal of Acute and Critical Care, 24(6), 474-482.

Fox, K. F., Nuttall, M., Wood, D. A., Wright, M., Arora, B., Dawson, E., Devane P., Stock, K., Sutcliffe, S. J., & Brown, K. (2001). A cardiac prevention and rehabilitation programme for all patients at first presentation with coronary artery disease. Heart, 85, 533-538.

Frasure-Smith, N., & Prince, R. (1989). Long term follow-up of the ischemic heart disease life stress monitoring program. Psychosomatic Medicine, 51, 485-513.

Fried, L. P., McNamara, R. L., Burke, G. L., & Siscovick, D. S. (1997). Heart health in older adults: Import of heart disease and opportunities for maintaining cardiac health. Western Journal Medicine, 167(1), 240-246.

Fukuzawa, S., Ozawa, S., Inagaki, M., Morooka, S., & Inoue, T. (1999). Secondary prevention with lipid lowering therapy in familial hypercholesterolemia: A correlation between new evolution of stenotic lesion and achieved cholesterol levels after revascularization procedures. Internal Medicine, 38(4), 330-335.

Gallagher, E. J., Viscoli, C. M., & Horwitz, R. I. (1993). The relationship of treatment adherence to the risk of death after myocardial infarction in women. Journal of the American Medical Association, 270(6), 742-744.

Garrett, M. J. (1997). Chronic conditions. In J. M. Black, & E. Matassarin-Jacobs (Eds.), Medical-surgical nursing (5th ed., pp.105-106). London: W. B. Saunders Company.

Gaw, B. L. (1992). Motivation to change life-style follow PTCA. Dimensions of Critical Care Nursing, 11(2), 68-74.

Gerard, P., & Tazbir, J. (2001). Management of clients with functional cardiac disorders. In J. M. Black, J. H. Hawks, & A. M. Keene (Eds.), Medical-surgical nursing (6th ed., pp. 1515-1529). Pennsylvania: W. B. Saunders Company.

Gulanick, M., Bliley, A., Perino, B., & Keough, V. (1998). Recovery patterns and lifestyle changes after coronary angioplasty: The patient’s perspective. Heart & Lung, 27(4), 253-262.

Hakim, A. A., Curb, J. D., Petrovitch, H., Rodriguez, B. L., Yano, K., Ross, G. W., White, L. R., & Abbott, R. D. (1999). Effects of walking on coronary heart disease in elderly men-The Honolulu heart program. Circulation, 100(1), 9-13.

Hofman-Bang, C., Lisspers, J., Nordlander, R., Nygren, A., Sundin, O., Ohman, A., & Ryden, L. (1999). Two-year results of a controlled study of residential rehabilitation for patients treated with percutaneous transluminal coronary angioplasty. The European Society of Cardiology, 20, 1465-1474.

Hommond, E. C., & Horn, D. (1958). Smoking and death rates：Report on forty four month of follow up of 187,783 men. 2. Death rates by cause. Journal of the American Medical Association Abstracts, 166(11), 1294-1308.

Huang, L. H. (1996). Medication-taking behavior of the elderly. The Kaohsiung Journal of Medical Science, 12(7), 423-433.

Hunt, K., Davison, C., Emslie, C., & Ford, G. (2000). Are perceptions of a family history of heart disease related to health-related attitudes and behaviour? Health Education Research, 15(2), 131-143.

Karlsson, I., Rasmussen, C., Ravn, J., Thiis, J. J., Pettersson, G., & Larsso, P. A. (2002). Chest pain after coronary artery bypass: Relation to coping capacity and quality of life. Scandinavian Cardivascular Journal, 36(1), 41-47.

King, K. M., Humen, D. P., Smith, H. L., Phan, C. L., & Teo, K. K. (2001). Psychosocial components of cardiac recovery and rehabilitation attendance. Heart, 85(1), 290-294.

Lisspers, J., Sundin, O., Hofman-Bang, C., Nordlander, R., Nygren, A., Ryden, L., & Ohman, A. (1999). Behavioral effects of a comprehensive, multifactorial program for lifestyle change after percutaneous transluminal coronary angioplasty: A prospective, randomized, controlled study. Journal of Psyshosomatic Research, 46(2), 143-154.

Meillier, L. K., Lund, A. B., & Kok, G. (1997). Cues to action in the process of change lifestyle. Patient Education and Counseling, 30, 37-51.

Muhlestein, J. B., Horne, B. D., Bair, T. L., Li, Q., Madsen, T. E., Pearson’s, R. R., & Anderson, J. L. (2001). Usefulness of in-hospital prescription of statin agents after angiographic diagnosis of coronary artery disease in improving continued compliance and reduced mortality. The American Journal of Cardiology, 87, 257-261.

Murphy, M. C., Fishman, J., & Shaw, R. E. (1989). Education of patients undergoing coronary angioplasty: Factors affecting learning during a structured educational program. Patient Education and Counseling, 18(1), 36-45.

Nikolaus, T., Kruse, W., Bach, M., Specht-Leible, N., Oster, P., & Schlierf, G. (1996). Elderly patients’ problems with medication: An in hospital and follow-up study. European Journal of Clinical Pharmacology, 49(4), 255-259.

Nordmann, A., Heilmbauer, I., Walker, T., Martina, B., & Battegay, E. (2001). A case-management program of medium intensity does not improve cardiovascular risk factor control in coronary artery disease patients: The heart care I trial. The American Journal of Medicine, 110(1), 543-550.

Nunnally, J. C., & Burnstein, I. H. (1994). Psychometric Theory (3th ed., p. 265). NY: McGraw-Hill.

Ornish, D., Scherwitz, L. W., Billings, J., Gould, K. L., Merritt, T. A., Sparler, S., Armstrong, W. T., Ports, T. A., Kirkeeide, R. L., Hogeboom, C., & Brand, R. J. (1998). Intensive lifestyle changes for reversal of coronary heart disease. The Journal of the American Medical Association, 280(23), 2001-2007.

Pedhazur, W. J. (1997). Categorical dependent variable: Logistic regression. Multiple regression in behavioral research (3th ed., pp. 714-739). Latin America: Thomson Learning.

Shah, P. B., & Lilly, C. M. (2002). Interventional therapy for coronary artery disease. American Journal of Respiratory and Critical Care Medicine, 166, 791-796.

Steptoe, A., Doherty, S., Rink, E., Kerry, S., Kendrick, T., & Hilton, S. (1999). Behavioural counseling in general practice for the promotion of healthy behaviour among adults at increased risk of coronary heart disease: Randomized trial. British Medical Journal, 319(7215), 943-947.

Stovsky, B. (1992). Nursing interventions for risk factor reduction. Nursing Clinics of North America, 27(1), 257-70.

Turner, L., Linden, W., Van der Wal, R., & Schamberger, W. (1995). Stress management for patients with heart disease: A pilot study. Heart and Lung: Journal of Critical Care, 24(2), 145-153.

Twisk, J. W. R., Kemper, H. C. G., Mechelen, W. V., & Post, B. (2001). Clustering of risk factors for coronary heart disease: The longitudinal relationship with lifestyle. Annals of Epidemiology, 11(3), 157-165.

Vliestra, R. E., Kronmal, R. A., Oberman, A., Frye, R. L., & Killip, T. 3rd. (1986). Effect of cigarette smoking on survival of patient with angiographically documented coronary artery disease. Report from the CASS registry. Journal of the American Medical Association Abstract, 255(8), 1023-1027.

Walker, S. N., Sechrist, K. R., & Pender, N. J. (1987). The health promoting lifestyle profile: Development and psychometric characteristics. Nursing Research, 36(2), 77-81.

Wallner, S., Watzinger, N., & Lindschinger, M. (1999). Effects of intensified lifestyle modification on the need for further revascularization after coronary angioplasty. European Journal of Clinical Investigation, 29(1), 372-379.
Wang, S. P., Chan, W. L., Ko, Y. L., Hsieh, I. C., Chen, J. J., Liu, C. P., Wu, C. J., Ho, H. Y., Lee, K. W., Chen, P. H., Young, M. S., Chern, C. I., Tsai, L. M., Fang, C. C., Yang, S. P., Chen, Z. C., Hung, J. S., Hsia, C. P., & Ko, C. C. (1998). The first multicenter coronary stenting registration in Taiwan. Acta Cardiol Sin, 14, 160-169.

Wasserman, J., Whitmer, R. W., Bazzarre, T. L., Kennedy, S. T., Merrick, N., Goetzel, R. Z., Dunn, R. L., & Ozminkowski, R. J. (2000). Gender-specific effects of modifiable health risk factors on coronary heart disease and related expenditures. Journal of Occupational Environmental Medicine, 42, 1060-1069.

Williams, M. A. (1996). Cardiovascular risk-factor reduction in elderly patients with cardiac disease. Physical Therapy, 76(5), 469-479.

World Health Organization. (2003, May 27). Statistics. World Health Organization. Available://www.euro.who.int/health topics/statistics/en/