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研究生:廖豔雪
研究生(外文):LIAO-YEN-ESUEH
論文名稱:失智症患者家屬支持團體之Hill互動矩陣分析
論文名稱(外文):Caregivers'' Support Group of Relatives with Dementia: A Hill I nteraction Matrix Analysis
指導教授:周桂如周桂如引用關係
學位類別:碩士
校院名稱:國防醫學院
系所名稱:護理研究所
學門:醫藥衛生學門
學類:護理學類
論文種類:學術論文
論文出版年:2002
畢業學年度:90
語文別:中文
論文頁數:96
中文關鍵詞:失智症患者失智症患者家屬支持團體Hill互動矩陣
外文關鍵詞:dementiacaregiversupport groupHill interaction matrix
相關次數:
  • 被引用被引用:6
  • 點閱點閱:1976
  • 評分評分:
  • 下載下載:463
  • 收藏至我的研究室書目清單書目收藏:17
中文摘要
失智症患者由於喪失自我照顧之能力,加上病程之進展導致許多症狀出現,使失智症患者家屬在長期照護失智症患者的過程中,承受了身體、心理、家庭關係、社會生活、經濟、及工作等各層面之衝擊。而給予家屬支持的方法之一是成立支持團體,從有類似遭遇、類似經驗、類似感受的團體成員的分享,家屬可以得到支持。
本研究乃利用心理支持團體之模式,分析失智症患者家屬在團體過程中的心理感受與經驗,並藉由Hill互動矩陣分析團體成員在團體中之口語互動。於某精神科專科醫院老人精神科病房,住院之失智症患者家屬為對象共八位,接受由研究者設計主持的支持團體共八次,每週一次,每次九十分鐘。
研究結果顯示:(1)領導者與成員的口語互動行為變化是有一致性的;(2)支持團體對成員的治療價值是比較有幫助的;(3)支持團體的治療因子有普遍性、知識訊息的傳遞、利他性、情緒宣洩、團體凝聚力。
從研究結果可看出支持團體對失智症患者家屬的確是有幫助的,因此提出三點建議:(1)由醫院成立個案管理制度,集合失智症患者家屬,建立聯絡網,定期舉辦家屬的支持團體,並配合其他措施如喘息服務,有其他的人可以幫助照顧失智症患者,讓家屬可以走出家庭,參加支持團體。 (2)建議政府相關單位將失智症相關知識列為教育的一環,並將相關的知識拍成教學錄影帶,在社會上廣為流傳,在學生的教科書中也能加上這樣的章節,並在媒體上廣為宣傳,使這樣的知識變成一種常識。(3)希望政府相關單位整合失智老人相關的福利與社會資源,並且廣為宣傳讓民眾知道。
關鍵詞:失智症患者、失智症患者家屬、支持團體、Hill互動矩陣
ABSTRACT
Patients with dementia show different symptoms along with the progress of the illness. Eventually, the patients will lost the abilities of self-care. People suffer from tremendous impacts physically, psychologically, socially and economically while taking care of their relatives with dementia. It may jeopardize their work and family relationships after a long period of time. One of the most effective ways to help the relatives of dementia is support group. People find their strength and belongings with other members in the group who share the same experience and feelings.
This research conducted a support group in a psychiatric hospital. Researchers analyzed the caregiving experience of caregivers in each session. The verbal interactions among the group members were recorded and analyzed by researchers with the Hill Interactive Metrics. The subjects included eight members who were the caregivers of the patients with dementia. They joined the support group which was held in the outpatient clinic of a psychiatric hospital. The support group met once a week for 8 sessions, and each session lasted for 90 minutes.
The results of this study were as follows:(1) There was a consistency between the group leader and the group members in their verbal patterns. (2) Support group is helpful therapeutically to the group members. (3) The therapeutic factors in the support group included universality, imparting information, altruism, catharsis and group cohesion.
The results of the research showed that support group was helpful to the relatives of patients with dementia. Three suggestions are derived from the research results: (1) Implement the case management system to the hospital. Workers of the hospital could organize the relatives of patients with dementia, build the connecting networks among them, build up suppor groups, offer adult day-care, respite services…etc. The goal is to help the caregivers go out of their family circles and to join the support group with other people who have the same experience. (2) Stress the importance of dementia issue in society. The government should educate the public about dementia issue. Advertisements or films related to dementia issue should be established and coveraged by media. (3) Coordinate the resources and social welfare for caregivers of relatives with dementia.
Key Words: dementia, caregiver, support group, Hill interaction matrix
第一章 緒論
第一節 研究背景與動機…………………………………….…….1
第二節 研究目的與問題…………………………………………..4
第二章 文獻探討
第一節 失智症…..………………………………………………….6
一、阿滋海默氏型失智症…………………………………….8
二、血管性失智症…………………………………………….9
第二節 失智症患者家屬的衝擊………………………………….11
一、生理層面…………………………………………………..12
二、心理層面…………………………………………………..12
三、家庭層面………………………………………………….13
四、經濟層面…………………………………………………..14
五、社會層面………………………………………………….15
第三節 支持團體………………………………………………….16
一、支持團體的特性…………………………………………..17
二、支持團體的功能………………………………………….18
三、支持團體的過程評量…………………………………….19
第四節 以Hill互動矩陣分析團體過程的相關研究……………..27
第三章 研究方法
第一節 名詞解釋………………………………………………….31
一、失智症患者……………………………………………….31
二、失智症患者家屬………………………………………….31
三、支持團體………………………………………………….32
四、Hill互動矩陣…………………………………………..…32
第二節 研究對象…………………………………………………..32
第三節 研究過程………………………………………………….33
一、 預試階段………………………………………………..33
二、 正式研究階段…………………………………………..33
第四節介入方案…………………………………………………...34
一、團體方案………………………………………………….34
二、領導者……………………………………………………..35
三、協同領導者………………………………………………..36
第五節 研究工具………………………………………………….36
一、基本資料表………………………………………………..36
二、Hill 互動矩陣……………………………………………..36
第六節 資料分析與處理………………………………………….42
一、資料轉錄…………………………………………………..42
二、資料分析標準……………………………………………..42
三、資料之編碼………………………………………………..43
四、信度測試…………………………………………………..43
五、家屬經驗及感受分析……………………………………..44
第四章 研究結果………………………………………………………46
第一節 研究對象之基本資料……………………………………46
第二節 團體領導者與成員的口語行為變化 …………………..48
一、領導者的口語變化情形…………………………………48
二、成員的口語變化情形…………………………………….54
三、領導者與成員的口語變化情形…………………………57
第三節 失智症患者家屬之照顧經驗……………………………61
第四節 失智症患者家屬支持團體的感受………………………70
第五章 討論……………………………………………………………73
第一節 領導者與成員間的口語互動情形分析…………………73
一、領導者的口語互動情形…………………………………73
二、成員的口語互動情形…….……..…………………….…75
三、領導者與成員的口語互動情形…………………………76
第二節 支持團體對失智症患者家屬的助益…………………....79
第六章 結論與建議……………………………………………………81
第一節 結論………………………………………………………81
第二節 限制與建議………………………………………………82
一、研究限制………………………………………………..82
二、建議……………………………………………………..83
參考資料………………………………………………………………..85
附錄
參考文獻
王亞妮(1998)。居家護理主要照顧者之負荷。國立台灣大學碩士論
文,未出版,台北。
史曉寧、黃愛娟(1996)。家庭重病老年患者之主要照顧者壓力源和
其家庭功能因素之探討。榮總護理,13(2),138-146。
行政院主計處(2001)。國情統計通報。2001年4月3日,取自
http:/www.dgbas.gov.tw/dgbas03/bs3/analyse/new90131.htm.
孔繁鐘(1999)。譫妄、痴呆、失憶性疾患及其他認知疾患。於孔繁
鐘編譯DSM-Ⅳ精神疾病的診斷與統計(初版)(pp.138)。台北:
合記。
李民濱(2000)。老年精神醫學。於李民濱著實用精神醫學(二版)
(pp.360-366)。台北:國立台灣大學醫學院。
李淑瓊、吳淑霞(1998)。家庭照護者負荷與憂鬱之影響因素。護理
研究,6(1),57-67。
李宗海、陳獻宗(2000)。失智症簡介。當代醫學,6(12),438-442。
林信男、蔡茂堂、林憲(1984)。農村老人之精神疾病:恆春研究。
中華民國神經精神醫學會會刊,10(2),65-79。
林憲(1987)。老年期痴呆病人家庭實態之調查研究。行政院國家科
學委員會專題研究計劃成果報告。
林克能、王培寧、莊雅雲、劉秀枝(2000)。記憶力衰退抱怨:失智
症前兆。應用心理研究,7,73-88。
林敬程(2000)。失智老人家庭照顧者之負荷與支持性服務需求之探
討。高雄醫學大學碩士論文,未出版,高雄。
吳瓊滿(1999)。居家照顧者的負荷。美和專校學報,17,1-14。
洪昭安、林靜蘭、蕭淑貞(2000)。支持性團體於社區慢性精神分裂
患者的應用。榮總護理,17(1),33-40。
徐亞瑛、楊清姿、葉炳強(1996)。癡呆症患者及家庭之整合性社區
居家照顧模式---發展與評估。高雄醫學科學雜誌,12(6),359-369。
徐亞瑛(2000)。支持團體對失智症家屬之助益。應用心理研究,8,
33-35。
陳妙絹(1995)。戒菸團體之團體過程分析。國立台灣大學碩士論文,
未出版,台北。
陳惠姿、李孟芬(2000)。台灣失智者的照護現況與展望。應用心理
研究,7,191-199。
陳若璋、李瑞玲(1987)。團體諮商與治療研究的回顧評論。中華心
理衛生學刊,3(2),179-215。
陳碧玲(1990)。團體互動行為模式之分析。國立師範大學碩士論文,
未出版,彰化。
陳秉華、王麗斐(1990)。輔導策略與輔導效果實證研究的回顧與檢
討。教育心理學報,23,237-260。
溫金成、羅文傑、李俊泰、林健群(1998)。阿耳滋海默氏症。國防
醫學,26(1),11-14。
湯麗玉、葉炳強、陳良娟、謝碧容。(2000)失智症家屬支持團體成
效初探。應用心理研究,7,171-190。
湯麗玉、毛家舲、周照芳、陳榮基、劉秀枝(1992)。癡呆症老人照
顧者的負荷及其相關因素之探討。護理雜誌,39(3),89-98。
湯麗玉(1991)。癡呆症老人照顧者的負荷及其相關因素之探討。國
立台灣大學護理學研究所博士論文,未出版,台北。
楊孝榮(2001)。內容分析。於楊國樞、文崇一、吳聰賢、李亦園編
著社會及行為科學研究法下冊(九刷)(pp.903-927)。台北:東
華。
黃璉華(1989)。團體衛生教育-談成立支持團體。護理雜誌,36(4),
27-32。
熊德筠(1990)。如何應用支持性團體協助病人。護理雜誌,37(2),
91-96。
趙喬(1991)。訓練團體之領導者和成員互動關係對團體經驗內涵之
影響‧未發表的碩士論文,台北:輔仁大學應用心理研究所。
鄧光銳(1992)‧癡呆症。醫學繼續教育,2,686-690。
潘正德(1990)。一般性團體諮商、認知模式團體諮商對五專一年級
內向性適應欠佳男生的效果研究。光武工專學報,15,403-513。
潘正德(1996)。Hill口語互動行為與團體效果之關係暨相關因素之
研究─以家庭探索團體為例。中原學報,24(4),47-70。
潘正德(1998)。團體歷程中口語互動行為與相關變相之研究。中原
學報,26(4),73-97。
潘正德、夏允中(1998)。團體效果、口語行為及相關因素之研究─
以桃園家庭教育服務中心為例。中華心理衛生學刊,11(4),29-72。
潘正德(1999a)。不同理論取向團體的口語互動行為分析與團體效果
研究。中原學報,27(2),95-122。
潘正德(1999b)。團體動力學。台北:心理。
潘正德、陳清泉、王海苓、鄧良玉、陳成鳳(1995)。大學生團體諮
商歷程中的口語互動行為分析及影響團體效果相關因素之研
究。中原學報,23(2),43-56。
甄瑞興、賈淑麗、楊志賢(2000)。記憶門診成效初探。應用心理研
究,7,105-118。
謝麗紅(1995)。成長團體過程與團體效果之分析研究。國立台灣師
範大學博士論文,未出版,台北。
盧純華(1991)。精神分裂症病患家屬支持性團體過程分析研究。國
防醫學院護理學研究所碩士論文,未出版,台北。
蕭金菊(1995)。家屬長期照顧慢性病老人對支持性服務需求之探究。
東海大學社會工作研究所碩士論文,未出版,台中。
Abramowitz, I. A., & Coursey, R. D.(1989). Impact of educational
support group on family participants who take care of their
schizophrenia relatives. Journal of Consulting and Clinical
Psychology, 57, 232-236.
Almberg, B., Jannson, W., Grafstorm, M., & Winblad, M. (1998).
Differences between and within genders in caregiving strain: a
comparison between caregivers of demented and non-caregivers of
non-demented elderly people. Journal of Advanced Nursing, 28,
849-858.
Anesbensel, C. S., Pearlin, L. I., Mullan, J. T., Zarit, S. H., & Whitlatch,
C. J. (1995). Profiles in Caregiving . The Unexpected Career. lifornia: Academic.
Andersen, K., Lolk, A., Nielsen, H., Andersen, J., Olsen. C., & Kragh,
S. P. (1997). Prevalence of very mild to severce dementia in Denmark. Acta Neurologica Scandinavica, 96, 82-87.
Barlow, S., Hansen, W. D., & Fuhriman. (1982). Leader Communication
Style : Effects on Members of Small Groups. Small Group Behavior,
13, 518-531.
Barusch, A. S., & Spaid, W. M. (1991). Reducing caregiver burden
through short-term training: Evaluation findings from a caregiver
support project. Journal of Gerontological Social Work,17, 7-33.
Biegel, D. E., & Schulz, R. (1999). Caregiving and caregiver
interventions in aging and mental illness. Family Relations, 48,
345-354.
Bourgeois, M. S., & Schulz, R. (1996). Interventions for caregivers of patients with Alzheimer’s disease: A review and analysis of content,
process, and outcomes. International Journal Aging and Hnman Development, 43, 35-92.
Brown, PL. (1990). The burden of caring for a husband with Alzheimer’s disease. Home Health Nurse, 9, 33-38.
Caotes, D. (1995). The process of learning in dementia-carer support programmes: Some preliminary observations. Journal of Advanced Nursing, 21, 41-46.
Chiu, H. F. K., Lam, L. C. W., Chi, I., Leung, T., Li, S. W., & Law, W. T. (1998). Prevalence of dementia on Chinese elderly in Hong Kong. Neurology, 50, 1002-1009.
Chou, K. R. (1998). Caregiver burden: Structural equation modeling. [Chinese] Nursing Research, 6, 358-370.
Chou, K. R., LaMontagne, L. L., & Hepworth, J. T. (1999). Burden experienced by caregivers of relatives with dementia in Taiwan. Nursing Research, 48, 206-214.
Dillehay, R. C., & Sandys, M. R. (1990). Caregivers for Alzheimer’s patients: what we are learning from research. Int J Aging Hum Dev, 30, 263-285.
Doornbos, M. M. (1997). The problems and coping methods of caregivers of young adults with mental illness. Journal of Psychosocial Nursing, 35, 22-26.
Dunkin, J. J., & Anderson, H. C. (1998, July). Dementia caregiver burden: A review of the literature and guidelines for assessment and intervention. Neurology, 51, S53-S60.
Fitzgerald, G. (1989). Evvects of caregiving on caregiver spouses of stroke victims. AXON, 10, 85-88.
Fuhriman, A., Drescher, S., & Burilingame, G. (1984). Conceptualizing small group process. Small Group Behavior, 15, 427-440.
Gage, M. J., & Kinney, J. M. (1995). The aren’t for everyone: The impact of support group participation on caregiver’ well-being. Clinical Gerontologist, 16, 21-34.
George, L. K., & Gwyther, L. P. (1986). Caregiver well-being: A multidimensional examination of family caregivers of demented adults. Gerontologist, 26, 253-259.
Given, C. W., Collins, C. E., & Given, B.A. (1988). Source of stress among families caring for relatives with Alzheimer’s disease. Nurs Clin North Am, 23, 69-82.
Goldberg-Arnold, J. S., Fristad, M. A., & Gavazzi, S. M. (1999). Family psychoeducation : Giving caregivers what they want and need. Family Relations, 48, 411-417.
Greene, V. L., & Monahan, D. J. (1989). The effect of a support and education program on stress and burden among family caregivers to frail elderly persons. Gerontologist, 29, 472-477.
Gwyther, L. P. (1998). Social issues of the Alzheimer’s patient and family. The American Journal of Medicine, 104, 17S-21S.
Haley, W. E. (1997). The family caregiver’s role in Alzheimer’s disease. Neurology, 48, S25-S29.
Handerson, A. D. (1998). Preparing feminist facilitators: Assisting abused women in transitional or support-group settings. Journal of Psychosocial Nursing and Mental Health Services, 36, 25-33.
Hill, W. F. (1977). Hill Interaction Matrix (HIM). Small Group Behavior. 8, 251-259.
Isabelle, G., Louise, G., Maria, M., & Serge, G. (1999). Development of a functional measure for persons with Alzheimer’s disease : The disability assessment for dementia. The American Journal of Occupational Therapy, 53, 471-481.
Johnson, M. (1982). Support groups for parents of chronically ill children. Pediatric Nursing, 8, 160-163.
Jonathan, P., & Bridget, P. (1998). Forgotten people : Positive approaches to dementia care. Brookfield, Ashgate Publishing Company.
Kanas, N., & Smith, A. J. (1990). Schizophrenic Group Process: A
Comparison Replication Using the HIM-G. Small Group Behavior, 14, 246-252.
Kinney, Dreessen, C. K., Mannetter, R. & Cappenter, M. (1985). Support group. In G. M. Bulechek. (Ed.) Nursing Interventions Treatment for Nursing Diagnosis. (pp.185-197). Philadelphia: W. B. Saunders Company.
Krach, B. P., & Brooks, J. A. (1995). Identifying the responsibilities & needs of working adults who are primary caregivers. Journal of Gerontological Nrusing, 21, 41-50.
Land, H., & Harangody, G. (1990). A support group for parents of persons with AIDS. Families in Society: The Journal of Contemporary Human Services, October, 471-481.
Levine, J., & Lawlor, B. A. (1991). Family counseling and legal issue in Alzheimer’s disease. Psychiatr Clin North Am, 14, 385-396.
Lewis, J., & Mider, P. A. (1973). Effects of leadership style on content and work styles of short-term therapy groups. Journal of Counseling Psychology, 20, 137-141.
Lidoff, L., & Harris, P. (1985). Idea book on caregiver support groups. Washington, DC: National Council on Aging.
Liu, C. K., Lin, R. T., & Chen, Y. F. (1996). Prevalence of Dementia in an urban area in Taiwan. Journal of Formosa Medical Association, 95, 762-768.
Liu, H. C., Lin, K. N., & Teng, E. L. (1995). Prevalence and subtypes of dementia in Taiwan : a community survey of 5279 individuals. Journal of the American Geriatrics Society, 43, 144-149.
Magen, R. H., & Glajchen, M. (1999). Cancer support groups: Client outcome and the context of group process. Research on Social Work Practice, 9, 541-554.
Mangone, C. A., & Sanguinetti. (1993). Influence of feelings of burden on the caregivers perception as the patient’s functional status. Dementia, 4, 287-293.
Middleton, L. (1984). Alzheimer’s family support groups-A manual for group facilitators.Tampa, FL, USF Medical Center, Suncoat Gerontology Center.
Miller, J. E. (1998). Effective support groups. Indiana : Willowgreen Publishing.
Monking, H. S. (1994). Self-help groups for families of schizophrenic patients: Formation, development and therapeutic impact. Social Psychiatry Psychiatr Epidemiology, 29, 149-154.
Paradiso, C. (1983). Support group socialization for chronic dialysis patients. Nephrology Nurse, 5, 8-12.
Parks, S. H., & Pilisuk, M. (1991). Caregiver burden: gender and psychological costs caregiving. Am Orthopsy Assoc, 61, 501-509.
Periard, M. E., & Ames, B. D. (1993). Lifestyle changes and coping patterns among caregivers of stroke surviors. Public Health Nurs, 10, 252-256.
Philp, I., McKee, K. J., Meldrum, P., Ballinger, B, R., Gilhooly, M. L. M., & Gordon, D. S. (1995). Community care for demented and non-demented elderly people: a comparison study of financial burden, service use, and unmet needs in family supports. British Medical Journal, 310, 1503-1506.
Prachno, R. A., Kleban, M. H., Michaels, J. E., & Dempsey, N. P. (1990). Mental and physical health of caregiving spouses: development of a causal model. J Gerontology,45, 192-199.
Printz, F. V. (1990). Group process effect on caregiver burden. J Neurosci Nurs, 22, 164-168.
Rabins, P. V., Mace, N. L. & Lucas, M. J. (1982). The impact of dementia on the family. JAMA, 248, 333-335.
Rew, L., Fields, S., LeVee, L. C., Russell, M. C., & Leake, P. Y. (1987). A nursing model to peomote role mastery in family caregivers. Fam Community Health, 9, 52-64.
Rose, L. E. (1996). Families of psychiatric patient: A critical review and future research direction. Archives of psychiatric Nursing, 10, 67-76.
Rybak, C. J. & Brown, B. M. (1997). Group Conflict: Communication Patterns and Group Development. The Journal for Specialists in Group Work, 22, 31-42.
Schweiger, J. L., & Huey, R. A. (1999). Alzheimer’s disease: Your role in the caregiving eguation. Nursing99, 29, 34-41.
Silbergeld, S., Thune, E. S., & Manderscheid, R. W. (1980). Marital role dynamics during brief group psychotherapy : Assessment of verbal interaction. Journal of Clinical Psychology, 36, 2.
Sisson, C. J., Sisson, P. J., & Gazda. G. M. (1977). Extended group counseling with psychiatry residents: HIM and the Bonney Scale Compared. Small Group Behavior, 8, 351-360.
Szmukler, G. I., Herrman, H., Colusa, S., & Benson, A. (1996). A controlled trial of a counselling intervention for cargivers of relatives with schizophrenia. Social Psychiatry Psychiatric Epidemiology, 31, 149-155.
Toseland, R. W., & Rossiter,C. (1989). Group internention to support family caregivers: A review and analysis. The Gerontologist, 29, 438-448.
Toseland, R. W., Labrecque, M., Goebel, S., & Whitney, M. (1992). An evaluation of a group program for spouses of frail elderly veterans. The Gerontologist, 32, 382-390.
Toseland, R. W., Rossiter, C., Peak, T., & Smith, G. (1990). Comparative effectiveness of individual and group interventions to support family caregivers. Social Work, 35, 209-217.
Van, H. T., & Deans, C. (1995). A phenomenological study of families and psychoeducation suppout group. Journal of Psychosocial Nursing Health Services, 33, 7-12.
Werstlein, P. O., & Borders, L. D. (1997). Group process variables in group supervision. The Journal for Specialists in Group Work, 22(2), 120-136.
Wilkins, S. S., Castle, S., Tanzy, K., & Faohey, J. (1999). Immune function, mood, and perceived burden among caregiver participating in a psychoeducational intervention. Psychiatric Services, 50, 747-749.
Woo, J. I., Lee, J. H., Yoo, K. Y., Kim, C. Y., Kim, Y. K., & Shin, Y. S. (1998). Prevalence estimation of dementia in a rural area of Korea. Journal of the American Geriatrics Society, 46, 983-987.
Yalom, I. D. (1995). The theory and practice of group psychotherapy (4th ed.). New York: Basic Books : A Divission of HarperCollins Publishers, Inc.
Yamada, M., Sasaki. H., Mimori, Y., Kasagi, F., Sudob, S., & Ikeda, J. (1999). Prevalence and risk of dementia in the Japanes population: adult health study Hiroshima subjects. Journal of the American Geriatrics Society, 47, 189-195.
Yip, P. K., Shyu, Y. I., & Liu, S. I. (1992). An epidemiological survey of dementia among elderly in an urban district of Taipei. Acta Neurology Sinica, 1, 347-354.
Zandi, T. (1990). Psychological difficulties of caring for dementia
Patients: The role of support groups. In Zandi, T., & Ham, R. J. (Eds.), New directions in understanding dementia and Alzheimer’s disease. New York: Plenum Press.
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