臺灣博碩士論文加值系統

背景：部分癌症化學藥物容易導致周邊神經病變，病人容易有疼痛或異常感覺問題，此為常見的生活品質議題，但國內相關研究有限。
目的：探討接受過化學藥物治療的乳癌、結直腸癌存活者周邊神經症狀與疼痛及其相關因素之影響。
方法：採用描述性相關性研究設計。以方便性取樣的方式，於北部某醫療機構招募130位接受過化學藥物治療且診斷至少一年的乳癌或結直腸癌病人，進行問卷調查與病歷資料收集。研究工具包括簡明疼痛量表、化學治療相關周邊神經症狀困擾量表、神經性疼痛症狀量表。
結果：樣本平均年齡為61.4（SD= 9.19）歲，以女性、已婚、高中職/專科畢業、無工作或退休者居多。其中乳癌佔68.5%，結直腸癌佔31.5%，癌症分期以II、III期居多，平均罹癌4.9年。結果呈現此類病人相關症狀嚴重程度雖低卻有高頻率的症狀感受。依10分量表，周邊神經症狀困擾為2.8分、神經性疼痛為0.9分、整體疼痛強度1.8分、疼痛干擾為1.1分。但過去一週有疼痛者佔60.8%，曾有化學治療相關周邊神經症狀者佔93.1%，有自發、誘發性或感覺異常疼痛者佔80.8%。多變量線性迴歸分析顯示，整體疼痛強度及干擾則隨疼痛處置、自發性持續疼痛及異常感覺嚴重程度增加而增加；而且癌症晚期病人的疼痛強度較高；而誘發性疼痛及肌肉無力較嚴重者，疼痛生活干擾較多。化學治療後相關周邊神經症狀困擾隨標靶藥物治療、與自發性持續疼痛及誘發性疼痛嚴重程度增加而增加。而神經性疼痛則隨異常感覺、肌肉無力及關節疼痛或肌肉抽筋嚴重程度增加而增加。所以醫護團隊應加強癌症存活者與化學藥物治療相關周邊神經症狀的評估，以早期提供處置減少生活品質衝擊。

Background: Patients who were treated with chemotherapy may be prone to chemotherapy-induced peripheral neuropathy (CIPN), and the problem of its coexistence of pain or paresthesia is a common issue of quality of life. But there were limited research in Taiwan.
Objective: To investigate the peripheral neurologic symptoms, pain and associated factors in breast or colorectal cancer survivors.
Methods: This is a correlation study. A total of 130 adults with breast cancer or colorectal cancer who had been treated with chemotherapy and diagnosed for at least one year were recruited via convenience sampling. Data gathered from medical records and questionnaires, including Brief Pain Inventory, Peripheral Nerve Symptom Distress Questionnaire and Neuropathic Pain Symptom Inventory.
Results: The sample had a mean age of 61.4 (SD = 9.19) ; mostly were female or married, with high school or diploma education, not working or retired. Most of them had breast cancer (68.5%), cancer of stage II/III. The results showed that these patients experienced low severity but high frequency of related CIPN and pain. According to 10-point scale, the peripheral neurological symptoms were 2.8, the neuropathic pain was 0.9, the overall pain severity was 1.8, and the pain interference was 1.1. However, 60.8% of the patients had pain in the past week, 93.1% reported CIPN symptoms, and 80.8% had neuropathic pain. Multivariate linear regression analysis showed that overall pain severity and interference increased as having pain management, and higher spontaneous persistent pain and paresthesia. Patients with advanced cancer also had higher pain severity. The pain interference on daily life also increased as higher provoked pain and muscle weakness. CIPN symptoms increased as receiving target therapy, and higher spontaneous persistent pain and provoked pain. Neuropathic pain increased as higher paresthesia, muscle weakness, joint pain or muscle cramps. Therefore, clinicians should actively assess peripheral neurological symptoms and its interference in cancer survivors who have received related chemotherapy.

中文摘要................................. i
英文摘要................................. ii
目 次.................................. iv
表 次.................................. vi
圖 次.................................. viii
第一章 研究動機與重要性
第一節 化學治療相關周邊神經症狀............1
第二節 癌症存活者的疼痛...................3
第三節 小結.............................4
第二章 文獻查證
第一節 乳癌、結直腸癌....................5
第二節 癌症化學藥物治療與周邊神經病變.......6
第三節 化學藥物相關周邊神經症狀之評估....... 10
第四節 癌症疼痛.........................11
第五節 小結............................14
第六節 研究問題.........................16
第七節 研究假設.........................16
第八節 研究架構.........................17
第九節 名詞解釋.........................17
第三章 研究方法
第一節 研究設計.........................19
第二節 研究樣本與取樣....................19
第三節 研究工具.........................22
第四節 研究過程.........................24
第五節 資料處理方法與統計分析............. 24
第四章 研究結果
第一節 研究樣本描述..................... 27
第二節 周邊神經症狀與疼痛................ 34
第三節 疼痛之相關因素....................44
第四節 周邊神經症狀困擾之相關因素.......... 57
第五節 周邊神經性疼痛之相關因素............ 62
第五章 討論
第一節 周邊神經症狀與疼痛.................69
第二節 周邊神經症狀與疼痛之相關性.......... 75
第三節 疼痛之相關因素....................77
第四節 周邊神經症狀之相關因素............. 80
第六章 結論與建議
第一節 結論............................83
第二節 研究限制與建議....................85
參考資料
中文部分...............................87
外文部分...............................87
附錄 研究工具............................99

中文部分
蔡婷芳(2008)‧肺癌病患接受化學治療引發周邊神經病變及其對情緒與睡眠品質的影響‧未發表的碩士論文‧臺北市：國立台灣大學護理學研究所。
衛生福利部國民健康署(2017年，12月)‧中華民國104年癌症登記報告‧取自http://www.hpa.gov.tw/Pages/Detail.aspx?nodeid=269&pid=8084
盧怜君(2012，1月)‧大腸直腸癌病人因化學治療引起之周邊神經性疼痛、日常活動功能、情緒及生活品質之相關性研究‧未發表的碩士論文‧台北市:國立臺北護理健康大學。

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