臺灣博碩士論文加值系統

「非潰瘍性消化不良」（non-ulcer dyspepsia,簡稱NUD）是「功能性消化不良」（functional dyspepsia）的一種，其定義是指病人上腹部或是近胸骨處有長期或復發的疼痛、胃灼熱感或是不舒服之症狀，此症會反覆的發作、自我緩解，並且沒有伴隨其他器質性的病因存在、對藥物的治療反應亦不一，因此常造成患者心理及社會醫療成本。
本研究目的為1.探討療效不佳之「非潰瘍性消化不良」病患使用抗憂鬱劑（Maprotiline）之輔助治療成效；2.探討哪些心理因素可以用來預測「非潰瘍性消化不良」對於抗憂鬱劑的效果。此研究自民國九十年九月至九十一年三月於胃腸內科經醫師診斷為療效不佳之「非潰瘍性消化不良」病患使用抗憂鬱劑之輔助治療成效，隨機將病患分為實驗組19人（服用Maprotiline 10mg）與控制組20人。所有的病患在研究前需完成心理測驗及症狀之評估。經服藥四週後，比較兩組在腹部症狀評分量表差異性。結果顯示實驗組與控制組在人口學變項上包括：性別、教育程度及婚姻狀況上經卡方檢定及年齡經由t檢定，結果顯示兩組沒有顯著性差異。
在心理因素檢定方面，經t檢定發現，「非潰瘍性消化不良」實驗組與控制組，兩組在壓力感受度變項（PSS）具有顯著性差異（t= -2.24,p＜0.05）。在憂鬱變項(BDI)及A型行為組型三個分量表上皆無顯著差異存在。
在胃腸症狀方面，以無母數魏可遜二獨立樣本檢驗，發現兩組在前測沒有顯著差異，在後測方面有顯著性差異（z= -2.36,p＜0.05）。結果顯示抗憂鬱劑(Maprotiline)對於療效不佳之「非潰瘍性消化不良」病患有治療效益。
在相關檢定方面，發現「非潰瘍性消化不良」與女性及憂鬱有顯著相關，且憂鬱程度較高者對於抗憂鬱劑（Maprotiline）反應較佳。

Nonulcer Dyspepsia, defined as persistent or recurrent abdominal pain or discomfort centered in the upper abdomen in patients who have no definite structural or biochemical explanation for their symptoms or other defined organic
diseases, is extremely common. It is generally chronic and is responsible for impaired quality of life as well as a large economic burden related to continued use of health services.
The aim of the study is （1）to investigate the beneficial effect of antidepressant（maprotiline） to the Non-ulcer dyspepsia ；（2）to survey psychological factors that can predict treatment outcome with an antidepressant in patients with non-ulcer dyspepsia.
39 NUD patients not response to the traditional drug therapy (antacid and prokinetic agent) are randomized to 4 weeks treatment of either maprotiline or placebo ,with a single-blind manner . All patients completed the Beck Depression Inventory（BDI）, Abdominal Symptom Rating Scale（ASRS）, Clo test, Perceived Stress Scale（PSS）, and Type A Behavior Pattern Scale for Chinese people） before treatment .Therapeutic response to pain and target symptoms were recorded with Abdominal Symptom Rating Scale（ASRS）every 2 week.
The results：patients taking maprotiline reported less abdominal pain, symptoms of abdominal distress, and functional disability than those given placebo（z=-2.36,p＜0.05）by Wilconxon test. Maprotiline is more superior to placebo, which may be an effective and well-tolerated pharmacologic treatment for Non-ulcer dyspepsia. Depression is a better predictor for treatment outcome with antidepressant therapy and non-ulcer dyspepsia is associated with likely to be an altered mechanism at the brain-gut axis in the process of gastric accommodation.

第一章 緒 論
第一節 研究動機………………………………… … … 1
第二節 研究目的 4
第二章 文獻回顧
第一節 非潰瘍性消化不良 5
第二節 抗憂鬱劑對「非潰瘍性消化不良」的療效 12
第三章 研究方法
第一節 研究假設 18
第二節 研究對象 18
第三節 研究工具 19
第四節 研究架構 25
第五節 資料分析方法 27
第四章 研究結果
第一節 資料特徵檢定 30
第二節 心理變項差異性檢 31
第三節 胃腸症狀量表前後測差異性檢定 33
第四節 人口學變相、心理因素與腹部症狀之相關檢定 34
第五節 結 論 34
第五章 討 論
第一節 人口學變項 36
第二節 「非潰瘍性消化不良」之心理因素檢定 37
第三節 「非潰瘍性消化不良」兩組在胃腸症狀差異檢定 39
第四節 治療機轉 40
第五節 人格特質預測「非潰瘍性消化不良」病患使用抗
憂鬱劑之療效 41
第六節 文獻回顧和本研究之異同
第六章 結論與建議
第一節 結 論 43
第二節 研究限制 43
第三節 建 議

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