臺灣博碩士論文加值系統

台灣尿毒透析病患搔癢比率仍偏高，約介於55-90%之間。搔癢症狀可能受到人口學特性、特質焦慮、生理參數、疾病特性及透析因素所影響，絕非單一因素即可造成。目前國外針對透析病患搔癢的相關研究繁多，但其結果多不一致，而國內有關透析病患的搔癢研究則付之闕如，故探討尿毒透析病患搔癢的相關因素是當前的重要課題之一。有鑑於此，本研究欲瞭解影響尿毒透析病患搔癢症之發生及其搔癢程度的相關因素。
本研究採橫斷式調查研究設計，以北市某醫學中心透析室為研究場所，利用結構式問卷進行資料收集，共收集110份有效問卷。研究問卷內容包含人口學特性、疾病特性、透析因素、生理參數、特質焦慮與皮膚搔癢量表等，收集到的資料以平均值、標準差、最大值、最小值、次數分配、百分比、卡方檢定、t檢定、曼惠尼-U檢定、邏輯式迴歸及線性迴歸等方式進行資料的分析與處理。
研究結果發現在尿毒透析病患中，搔癢發生的機率為70.9%。其中行腹膜透析者發生搔癢的佔72.4%，行血液透析者發生搔癢的佔67.6%；在搔癢病患中，平均皮膚搔癢量表得分為10.94分，下午的平均得分較上午為高。而與尿毒透析病患目前是否搔癢之最有力的影響因素包含透析前職業、腎臟疾病的種類、血氯及皮膚潮濕度等因素；與有搔癢之尿毒透析病患之搔癢程度最有力的影響因素則包含白蛋白、水分散失量及血氯等因素。
根據此研究結果得知，尿毒透析病患的皮膚潮濕度與目前是否搔癢有關，而水分散失量則與搔癢病患之搔癢嚴重程度有關，因此，當搔癢病患在尋求止癢之醫療措施時，亦應提供病患皮膚護理，衛教使用水性的皮膚潤滑劑，以改善皮膚乾燥的狀況並緩解搔癢，進而改善病患的睡眠障礙，以增進其生活品質為最終目的。

Uremic pruritus rate of dialytic patients is still high in Taiwan, roughly lies between 55% and 90%. There are many factors interacted each other to affect their pruritic symptom including the character of demography, trait anxiety, physiologic parameter, disease and dialysis. At present, there are many researches related to uremic pruritus at overseas, but their results are inconsistent. However, there is rare data to show the uremic pruritus of dialytic patients in Taiwan. Therefore, discussing the factors related to uremic pruritus of dialytic patients is one of the important issues.
As a result, the study was a cross-sectional study design. A valid sample of 110 patients were recruited from one of the dialytic room of medical centers in Taipei city. Data were collected by structured questionnaires. The questionnaires used included the character of demography, disease, dialysis, physiologic parameter, trait anxiety and pruritic scale. Data were analyzed by mean, standard deviation, minimal, maximal, frequency, percentile , Chi-Squire test, t test, Mann-Whithey U test, logistic regression and linear regression using SPSS Window 13.0.
Results showed that the pruritic incidence rate of uremic dialytic patients was 70.9%, the patients who received peritoneal dialysis was 72.4% and the patients who received hemodialysis was 67.6%. The mean of pruritic scale was 10.94 points in the itch patients and their mean point in the afternoon more than in the morning. However, the influential factors for pruritic symptom among uremic dialytic patients were the occupation of pre-dialysis, the kinds of renal disease, chloride and skin humidity. And the influential factors for pruritic severity among itch patients were the albumin, chloride and transepidermal water loss.
According to the results of this study, the skin humidity of uremic dialytic patients were related to the pruritic symptom and the transepidermal water loss among the itch patients were related to the severity. Therefore, we will provide patients skin nursing when they seek the intervention for relieving itch. We can teach them use the hydrant skin emollient to improve the dry skin and relieve itch. The finally propose that we want to improve the sleep disorder of the patients and gain the quality of life.

正文目錄
【碩士論文目次】 頁 數
第一章 緒論………………………………………………………………1
第一節 研究動機及重要性……………………………………………1
第二節 名詞界定………………………………………………………3
第三節 研究目的………………………………………………………4
第四節 研究概念架構…………………………………………………5
第五節 研究問題………………………………………………………6
第二章 文獻查證…………………………………………………………7
第一節 尿毒透析病患搔癢症之相關概念……………………………7
第二節 影響尿毒透析病患搔癢症之因素及其相關研究……………22
第三章 研究方法與過程…………………………………………………32
第一節 研究設計………………………………………………………32
第二節 研究對象與場所………………………………………………32
第三節 研究工具………………………………………………………33
第四節 資料收集過程…………………………………………………39
第五節 資料處理與分析………………………………………………40
第六節 研究倫理的考量………………………………………………41
第四章 研究結果…………………………………………………………42
第一節 尿毒透析病患基本資料特性…………………………………42
第二節 各變項與搔癢症之關係………………………………………53
第三節 尿毒透析病患搔癢症狀之重要預測變項……………………57
第四節 有搔癢之尿毒透析病患搔癢程度的重要預測變項…………60
第五章 討論………………………………………………………………63
第一節 尿毒透析病患搔癢發生率與搔癢之特性……………………63
第二節 影響尿毒搔癢症狀及其搔癢程度之因素……………………65
第六章 結論與建議………………………………………………………72
第一節 結論……………………………………………………………72
第二節 建議……………………………………………………………75
參考資料…………………………………………………………………..77
英文部分………………………………………………………………..77
中文部分……………………………………………………………..…83

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