臺灣博碩士論文加值系統

周邊動脈阻塞病患因為下肢血管阻塞，使病患行走時有間歇性跛行的症狀及疼痛，因而在行走功能上與自覺健康狀態受到限制。然而目前國內對這類病患的運動訓練以改善行走功能與自覺健康狀態的相關研究相當有限，故本研究目的在探討周邊動脈阻塞病患經由運動訓練後對其行走功能及自覺健康狀態上之影響。
本研究採類實驗設計法選取台北市北區某醫學中心，經由心臟血管外科專科醫師轉介周邊動脈阻塞病患為研究對象，依隨機方式將個案分為運動組及對照組，共有22位個案完成此研究，其中運動組10人，對照組12人。運動組參與為期八週的跑步機運動訓練，對照組則保持其原本生活方式，八週前後經結構式問卷、六分鐘行走測試與跑步機運動測試進行資料收集。資料分析採百分比、平均值、標準差、Spearman correction、Mann-Whitney U test、 及Wilcoxon Sign-Rank test，以探討跑步機運動訓練對周邊動脈阻塞病患對其自覺、實際行走功能與自覺健康狀態之成效。
研究結果發現：（一）周邊動脈阻塞病患在自覺健康狀態中得分屬於中等，身體功能層面得分較心理功能層面得分低。（二）基本屬性與病患自覺健康狀態並無顯著相關，年齡與病患實際六分鐘行走距離呈現負相關，收縮壓對於病患自覺行走距離亦呈現負相關。（三）運動訓練後，病患在自覺健康狀態中身體功能層面增加50%，較心理功能層面增加來的顯著，各次概念增加程度則由20%至178%。（四）運動訓練後，病患自覺行走功能有顯著的改善，改善程度由17%-36%。（五）運動訓練後，病患在實際行走功能有顯著的改善，其改善情形達168.9%-187.5%。
本研究結果顯示周邊動脈阻塞病患因行走功能受限，影響其自覺健康狀態，在經過八週的跑步機運動訓練後，對於周邊動脈阻塞病患在自覺行走功能、實際行走功能與自覺健康狀態皆達到顯著的成效。

There are great impact on the walking function and perception of health status due to limited arterial blood supply to lower extremities and intermittent claudication among patients with peripheral arterial occlusive disease. However, studies regarding the effects of exercise training on the patients'' walking function and perception of health status are very rare in Taiwan. The purpose of this study is to explore the effects of exercise training on the walking function and perception of health status in elderly patients with peripheral arterial occlusive disease.
A quasi-experimental design was used to guide the study. Subjects who met the criteria were referred by a cardiovascular surgeon at a medical center in Taipei. Twenty two patients enrolled in our study who were randomly assigned into either exercise or conrtrol group. The exercise group was assigned to join an 8-week treadmill exercise program. The control group remained their living pattern. Data were collected by the structural questionnaires, 6-minute walking test and treadmill exercise test. Percentage, mean, standard deviation, Spearman correlation, Mann-Whitney U test and Wilcoxon Sign-Rank test were used for the data analysis.
Research results were shown as follows: （1） Patients perceived moderate degree of health status and reported lower scores in physical function dimension than in psychological dimension. （2） Age was negatively correlated with 6-minute walking distance. Systolic blood pressure was negatively correlated with perceived walking function. （3） The perception of health status of patients was improved by 20%~178% after exercise training program. The physical function dimension of perceived of health status improved more significant than the psychological dimension. （4） Patients perceived better of walking function by 17%~36% after exercise training program. （5） The actual walking function by 168.9% to 157.5% of the patients was increased after exercise training.
Based on the results of this study, it was concluded that there was a great impact on patients'' perception of health status due to their limited walking function. After paticipating in an 8-week treadmill exercise training program, the patients indeed improved their perception of health status and walking function.

目 錄
頁 數
致 謝 ………………………………………………………………….Ⅰ
中文摘要 ………………………………………………………………….Ⅱ
英文摘要 ………………………………………………………………….Ⅳ
目 錄 ………………………………………………………………….Ⅵ
表 目 次 ………………………………………………………………….Ⅸ
圖 目 次 …….……………………………………………………………Ⅹ
第一章 緒論1
第一節 研究動機與重要性2
第二節 研究目的4
第三節 研究假設4
第四節 名詞界定5
第二章 文獻查證6
第一節 周邊動脈阻塞疾病6
第二節 周邊動脈阻塞疾病對病患之影響14
第三節 運動訓練對周邊動脈阻塞疾病之影響17
第四節 研究架構24
第三章 研究方法25
第一節 研究設計25
第二節 研究對象及場所26
第三節 研究工具27
第四節 運動訓練計畫32
第五節 資料收集過程35
第六節 資料統計分析37
第四章 研究結果38
第一節 周邊動脈阻塞病患描述性統計38
第二節 運動訓練前周邊動脈阻塞病患自覺健康狀態44
第三節 周邊動脈阻塞病患自覺行走功能47
第四節 周邊動脈阻塞病患實際行走功能47
第五節 基本屬性對病患自覺健康狀態影響50
第六節 基本屬性對病患自覺與實際行走功能影響50
第七節 運動訓練對周邊動脈阻塞病患自覺健康狀態成效55
第八節 運動訓練對病患自覺與實際行走功能成效61
第伍章 討論69
第一節 基本屬性對病患自覺健康狀態與行走功能影響69
第二節 運動訓練對病患自覺健康狀態成效72
第三節 運動訓練對病患自覺行走功能成效75
第四節 運動訓練對病患實際行走功能成效77
第六章 結論與建議79
第一節 結論79
第二節 研究限制81
第三節 應用與建議82
參考資料 85
中文部分 85
英文部分 86
附錄一 參與研究計畫同意書 92
附錄二 運動測試記錄表 93
附錄三 運動訓練記錄表 94
附錄四 周邊動脈阻塞病患個人基本資料 95
附錄五 自覺健康狀態量表說明 96
附錄六 醫療成果研究量表 98
附錄七 行走功能損傷量表 103
附錄八 行走損傷量表使用同意書 106

中文部分
尹祚芊等（1996）‧公共衛生護理學（pp. 25-30）‧台北：華杏。
行政院衛生署（2000）‧ 衛生統計--（2）生命統計‧台北：三民。
林萬鈺、鄒中泰、高嘉鴻、許忠源、廖澍昆、王世楨（1993）‧正常中國人下肢肌肉血流量之測定及不同年齡、性別之影響‧ 高雄醫學科學雜誌， 9（2），89-93。
徐仁熙（1989）‧ 醫護病理學‧台北：華杏。
侯瑞城（1994）‧基礎病理學‧ 台北：藝軒。
黃伯超、游素玲、林月美、朱志良（1992）‧我國成年人性別、年齡別、身高別體重及過重與肥胖界定之探討‧中華民國營養學會雜誌，17 （1），157-172。
陳曉宜（1999）‧步行機訓練對於慢性周邊動脈阻塞疾病患者效果之研究‧未發表碩士論文，台北：國立台灣大學。
楚恆毅、劉復康（1999）‧日常生活活動的功能性評估簡介‧國防醫學，28（6），451-461。
楊梅香 (2000)‧充血性心臟衰竭患者運動耐力對其生活品質影響探討‧未發表碩士論文，台北：台北醫學院。
蔡文鐘、王亭貴、賴金鑫（1995） 糖尿病患者之運動‧ 當代醫學22（2），97-103。
鄭綺（1999）‧冠狀動脈繞道述患者最大攝氧量、自覺體能效能及生活品質之探討. 護理研究，7（6），531-541。
戴玉慈、羅美芳（1996）‧身體功能評估的概念與量表‧護理雜誌，43（2），63-68。
英文部分
American College of Sports Medicine. (1995). ACSM’s guideline for exercise testing and prescription (5th ed.). Media, PA : Williams & Wilkins.
American College of Sports Medicine. (2000). ACSM’s guideline for exercise testing and prescription (6th ed.). Media, PA : Williams & Wilkins.
Applegate, W. (1992). Ankle/arm blood pressure index: A useful test for clinical practice? JAMA, 270(4), 497-498.
Bainton, D., Sweetnam, P., Baker, I., & Elwood, P. (1994). Peripheral vascular disease: Consequence for survival and association with risk factors in the Speedwell prospective heart disease study. British Heart Journal,72(2), 128-132.
Cahan, M. A., Montgomery, P., Otis, R. B., Clancy, R., Flinn, W., & Gardner, A. (1999). The effect of cigarette smoking status on six-minute walk distance in patients with intermittent claudication. Angiology, 50(7), 537-546.
Capecchi, P. L., Pasini, F. L., Cati, G., Colafati, M., Acciavatti, A., Ceccatelli, L., Petri, S. de Lalla A., & Di, Perri T. (1997). Experimental model of short-time exercise-induced preconditioning in POAD patients. Angiology, 48(6), 469-479.
Cooke, J. P., & Ma, A. O. (1995). Medical therapy of peripheral arterial occlusive disease. Surgical Clinics of North America, 75(4), 569-579.
Criqui, M. H., Fronek, A., Barrett-Connor, E., Klauber, M. R., Gabriel, S., & Goodman, D. (1985). The prevalence of peripheral arterial disease in a defined population. Circulation, 71(3), 510-515.
Ensrud, K. E., Nevitt, M. C., Yunis, C., Cauley, J. A., Seeley, D. G., Fox, K. M., & Cummings, S. R. (1994). Comparative stuides of imparied function in older women. Journal of the Amercian Geriatric Society, 42(5), 481-489
Feinglass, J., McCarthy, W. J., Slavensky, R., Manheim, L. M., Martin, G. J., & the Chicago Claudication Outcome Research Group. (1996). Effect of lower extremity blood pressure on physical functioning in patients who have intermittent claudication. Journal of Vascular Surgery, 24(4), 503-512.
Fowkes, F. G. (1988). The measurement of atherosclerotic peripheral arterial disease in epidemiological surveys. International Journal of Epidemiology, 17(2), 248-254.
Fowkes, F. G., Housley, E., Cawood, E. H., Hacintyre, C. C., Ruckley, C. V., & Prescott, R. J. (1991). Edinburgh artery study: Prevalence of asymptomatic and symptomatic peripheral arterial disease in the general population. International Journal of Epidemiology, 20(2), 384-392.
Gahtan, V. (1998). The noninvasive vascular laboratory. Surgical Clinics of North America, 78(4), 507-517.
Gardner, A. W., & Poehlman, E. T. (1995). Exercise rehabilitation programs for the treatment of claudication pain. A meta-analysis. JAMA, 274(12), 975-980.
Gardner, A. W., Skinner, J. S., Cantwell, B. W., & Smith, L. K. (1991). Progressive vs single-stage treadmill tests for evaluation of claudication. Medicial & Socience in Sports & Exercise, 23(4), 402-408.
Gardner, A. W., Sieminski, D. J., & Killewich, L. A. (1997). The effect of cigarette smoking on free-living daily physical activity in older claudication patient. Angiology, 48(11), 947-955.
Gillum, R. F. (1990). Peripheral arterial occulative disease of the extremities in the United States: Hospital and mortality. American Heart Journal, 120(Pt. 1), 1414-1418.
Hale, W. E., Marks, R. G., May, F.E. Moore, M. T., & Stewart, R. B. (1988). Epidemiology of intermittent claudication: Evaluation of risk factor. Age and Aging, 17(1), 57-60.
Hiatt, W. R., Hirsh, A. T., Regensteiner, J. G., & Brass, E. P. (1995). Clinical trials for claudication assessment of exercise performances, functional status, and clinical end points. Circulation, 92(3), 614-621.
Hiatt, W. R., Marshall, J. A., Baxter, J., Sandoval, R., Hildebrandt, W., Kahn, L. R., & Hamman, R. F. (1990). Diagnostic methods for peripheral arterial disease in the San Luis Valley Diabetes Study. Journal of Clinical Epidemiology, 43(6), 597-606.
Hiatt, W. R., Nawaz, D., Regensteiner, J. G., & Hossack, K. F. (1988). The evaluation of exercise performace in patients with peripheral vascular disease. Journal of Cardiopulmonary Rehabilitation, 12(3), 525-532.
Housley, E. (1988). Treating claudication in five words. British Medicine Journal, 296(6635), 1483-1484.
Kannel, W. B., & McGee, D. L. (1985). Update on some epidemiologic features of intermittent claudication: The Framingham Study. Journal of the American Geriatrics Society, 33(1), 13-18.
Leng, G. C., Fowkes, F. G., Lee, A. J., Dunbar, J., Housley, E., & Ruckley, C. V. (1996). Use of ankle brachial pressure index to predictor cardiovascular events and death: A cohot study. British Medicine Journal, 313(7070), 1440-1444.
McCully, K., Leiper, C., Sanders, T., & Griffin, E. (1999). The effects of peripheral vascular disease on gait. Journal of Gerontology, Series A, Biological Science & Medical Science, 54(7), B291-B294.
McDermott, M. M., Liu, K., Guralnik, J. M., Martin, G. J., Criqui, M. H., & Greenland, P. (1998). Measurement of walking endurance and walking velocity with questionaie: Validation of the walking impairement questionaire in men and women with peripheral aterial disease. Journal of Vascular Surgery, 28 (6),1072-1081.
McDermott, M. M. (1999). Ankle brachial index as a predictor of outcomes in peripheral arterial disease. Journal of Laboratory & Clinical Medicine, 133(1), 33-40.
McDermott, M. M., & McCarthy, W. (1995). Intermittent claudication. Surgical Clinics of North America, 75(4), 581-591.
McHorney, C. A., Ware, JE. JR., & Raczek, A. E. (1993). The MOS 36-item Short-Form Health Survey (SF-36): Psychometric and clinical tests of validity in measuring physical and mental health constructs. Medical Care, 31(3), 247-263.
McKenne, M., Wolfson, S., & Kuller, L. (1991). The ratio of ankle and arm arterial pressure as an independent predictor of mortality. Atherosclerosis, 87(2-3), 119-128.
Medical Outcome Trust. (1994). How to score the SF-36 health survey. Boston, MA: Medical Outcome Trust.
Montgomery, P. S., & Gardner, A. W. (1998). The clinical utility of a six-minute walk test in peripheral arterial occlusive disease patients. The American Geriatrics Society, 46(6), 706-711.
Murabito, J. M., D’Agostino, R. B., Sillbershatz, H., & Wilson, W. F. (1997). Intermittent claudication: A risk profile from the Framingham Heart study. Circulatin, 96(1), 44-49.
Nehler, M. R., & Hiatt, W. R. (1999). Exercise therapy for claudication. Annals of Vascular Surgery, 13(1), 103-113.
Patterson, R. B., Pinto, B., Marcus, B., Colucci, A., Braun, T., & Roberts, M. (1997). Value of supervised exercise program for the therapy of arterial claudication. Journal of Vascular Surgery, 25(2), 312-318.
Ponte, E., & Cattinelli, S. (1996). Quality of life in a group of patients with intermittent claudication. Angiology, 47(3), 247-251.
Quick, C. R. G., & Cotton, L. T. (1982). The measured effect of stopping smoking on intermittent claudication. British Journal of Surgery, 69(Suppl.), S24-S26.
Regensteiner, J. G. (1997). Exercise in the treatment of claudication: Assessment and treatment of functional impairment. Vascular Medicine, 2, 238-242.
Regensteiner, J. G., & Hiatt, W. R. (1994). Medical management of peripheral arterial disease. Journal of Vascular and International Radiology, 5(5), 669-677.
Regensteiner, J. G., Meyer, T. J., Krupski, W. C., Cranford, L. S., & Hiatt, W. R. (1997). Hospital vs home-based exercise rehabilitation for patients with peripheral arterial occlusive disease. Angiology,48(4), 291-300.
Regensteiner, J. G., Steiner, J. F. & Hiatt, W. R. (1996). Exercise training improves functional status in patients with peripheral arterial disease. Journal of Vascular Surgery. 23(1), 104-115.
Regensteiner, J. G., Steiner, J. F., Panzer, R. J., & Hiatt, W. R. (1990). Evaluation of walking impairment by questionnaire in patients with peripheral arterial disease. Journal of Vascular Medicine & Biology, 2(3), 142-152.
Rudofsky, G. & Vah Laak, H. H. (1994). Treatment costs of peripheral occlusive disease in Germany: a comparison of costs and efficacy. Journal Cardiovascular Pharmacology, 23(Suppl. 3), 22-25.
Santilli, J. D., Rodnick, J. E., & Santilli, S. (1996). Claudication: Diagnosis and treatment. American Family Physician, 53(4), 1245-1253.
Scheffler, P., Hamett, D., Gross, J., & Mueller, H. (1994). Intensive vascular training in stage Iib of peripheral arterial occlusive disease: The additive effects of intravenous prostaglandin E1 or intravenous pentoxifylline during training. Circulation, 90(2), 818-822.
Scherer, S. A., Bainbridge, J. S., Hiatt, W. R., & Regensteniner, J. G. (1998). Gait characteristics of patients with claudication. Archives of Physical Medicion & Rehabilitation, 79(5), 529-531.
Sieminski, D. J., & Gardener, A. W. (1997). The relationship between free-living daily physical activity and the severity of peripheral arterial occlusive disease. Vascular Medicine, 2(4), 286-291.
Smith, F. B., Lowe, G. D. O., Lee, A. J., Rumley, A., Leng, G. C., & Fowkes, F. G. R. (1998). Smoking, hemorheologic factors, and progression of peripheral arterial disease in patients with claudication. Journal of Vascular Surgery, 28(1), 129-135.
Tan, K. H., De Cossart, L., & Edwards, P. R. (2000). Exercise training and peripheral vascular disease. British Journal of Surgery, 87(5), 553-562
Törnwall, M. E., Virtamo, J., Haukka, J. K., Aro, A., Albanes, D., & Huttunen, J. K. (2000). Prospective study of diet, lifestyle , and intermittent claudication in male smokers. American Journal of Epidemology, 151(9), 892-901.
Tunis, S. R., Bass, E. B., & Steinberg, E. P. (1991). The use of angioplasty, bypass surgery, and amputation in the management of the peripheral vascular disease. New England Journal of Medicine,325(8), 556-562.
Vogt, M., Wolfson, S., & Kuller, L. (1992). Lower extremity arterial disease and the aging process: A review. Journal of Clinical Epidemiology, 45(5), 529-542.
Vogt, M. T., Cauley, J. A., Kuller, L. H., & Nevitt, M. C. (1994). Function status and mobility among elderly women with lower extremity arterial disease: The study of osteoprotic fractures. Journal of the American Geriatrics Society, 42(9), 923-929.
Ware, J. E., & Sherbourne, C. D. (1992). The MOS 36-item short-form health survey (SF-36) I: Conceptual framework and item selection. Medical Care, 30(6), 473-483.