臺灣博碩士論文加值系統

末期腎病變為不能治癒的慢性疾病，台灣每年新個案數約有六千人，有逐年增加的趨勢。隨著醫學的進步，延長了末期腎病患者的存活，然而患者必須接受長期血液透析以維持生命，而透析治療期間的疲倦、失眠及焦慮、憂鬱等症狀困擾嚴重的影響生活品質。本研究目的旨在探討足部按摩治療對血液透析患者疲憊感受、睡眠品質、焦慮及生活品質之成效。本研究採雙盲隨機實驗研究設計，以北區某醫學中心之二個血液透析單位，經由電腦資料庫中篩選符合選樣條件之個案120名，再依隨機對照分派表分派至實驗組、對照組A及對照B三組，共83位患者參與，三組除接受一般常規照護之外，實驗組患者於血液透析期間接受六次的足部按摩治療，對照組A組接受六次的耳穴貼壓治療，對照組B則使用安慰貼片。三組在介入措施前、後以結構式問卷進行訪談收集資料，測量工具包括簡明疲憊量表、睡眠品質量表、焦慮憂鬱量表及生活品質量表四部分。以SPSS 12.0 for windows統計套裝軟體進行分析，包括描述性統計、單因子變異數分析和
Generalized linear mixed-effects model。研究結果顯示VAS量表方面，疲憊及睡眠呈
顯著差異（p＜0.05），而焦慮VAS未達統計顯著差異（p＞0.05）。疲憊、睡眠、
焦慮憂鬱、生活品質量表得分已達統計顯著差異（p＜0.05）；以不同時間點測量
VAS，而組別及時間產生交互作用，實驗組在後測結果顯著優於對照組（p＜0.05），
足部按摩介入對疲憊及睡眠有顯著影響，並在停止介入後有2天持續效果。以不
同時間點測量疲憊、睡眠品質、焦慮憂鬱及生活品質成效，隨著測量時間點之不
同，組別與時間呈現交互作用，示實驗組在後測時間點優於控制組（p＜0.05）。
但在追蹤後測時已回復前測得分狀態（p＞0.05）。本研究結果發現足部按摩治療
對末期腎病患者疲憊、睡眠品質、焦慮及生活品質有顯著成效，提供護理人員照
護末期腎病患者之參考，以協助指導主要照顧者學習足部按摩技巧，減少因疾病
和治療過程引發不適之症狀，進而提昇末期腎疾病患者之生活品質。

Fatigue, insomnia, Anxiety , Depression are disabling symptoms in patients with End-Stage Renal Disease on dialysis. The purpose of this study was to explore the effect of Foots Reflexotherapy on Fatigue, quality of sleep, Anxiety , Depression and quality of life in Patients with End-Stage Renal Disease who were undergoing hemodialysis. It was an experimental design and randomized sampling from the wards of hemodialysis department of a medical center located in Taipei city. Eighty three Patients were randomly assigned into experimental group and control group A, B. Patients in the experimental group received Foots Reflexotherapy. The control group A received auricular acupressure, and control group B received the placebo procedure. The effectiveness was measured by the Brief Fatigue Inventory, The Pitsburgh Sleep Quality Index; Hospital Anxiety Depression Score, Short- Form 12 Norms Quality of Life and Visual Analogue Scale. All the data were analyzed by SPSS 12.0 for windows. The statistical methods applied in data management were: descriptive statistics, One way ANOVA and Generalized linear mixed-effects model. The results indicated that the Visual Analogue Scal for Fatigue and Quality of Sleep ,there’s statistically significant different(p＜.05). The subjects in the experimental group had significant improvement in their fatigue, quality of sleep, anxiety and quality of life (p＜.05). In conclusion, the Foots Reflexotherapy was effective in improving quality of sleep and quality of life, and there’s statistically significant improvement in the fatigue, anxiety perception. By the result, we suggest that Foots Reflexotherapy may be included as part of the hemodialysis nursing care to relieve the fatigue and anxiety, and improving quality of life.


Keywords: End-Stage Renal Disease; Foots Reflexotherapy; Fatigue; quality of sleep;
Anxiety; Depression and quality of life

第一章 緒論 ……………………………………………………………… 1-4
第一節 研究動機及重要性……………………………………………… 1-3
第二節 研究目的…………………………………………………………. 4
第二章 文獻查證 ……………………………………………………………5-28
第一節 末期腎病變之治療現況………………………………………. …5
第二節 血液透析患者之身體症狀困擾及其相關因素 …………………6-7
第三節 足部按摩治療 ……………………………………………………7-13
第四節 耳穴貼壓治療 ……………………………………………………14-19
第四節 疲憊感受 …………………………………………………………20-22
第五節 睡眠品質 ……………………………………………………... …22-23
第六節 焦慮與憂鬱………………………………………………………..24-26
第七節 生活品質 ………………………………………………………… 26-28
第八節 總結 ……………………………………………………………… 28
第三章 研究方法 …………………………………………………………… 29-45
第一節 研究架構 ………………………………………………………… 30
第二節 研究假設 ………………………………………………………… 31
第三節 名詞界定 ………………………………………………………… 31-32
第四節 研究設計 ………………………………………………………… 33-34
第五節 研究對象與場所 ………………………………………………….35
第六節 倫理考量 ………………………………………………………….36
第七節 研究介入方案 …………………………………………………… 37-38
第八節 研究工具與信效度 ……………………………………………… 39-43
第九節 研究步驟 ………………………………………………………… 44
第十節 資料處理與統計分析 ………………………………………..….. 45
第四章………………………………………………………………………….46-82
第一節 研究對象基本資料與疾病屬性…………………………………. 46-50
第二節 研究對象接受介入措施前、後之生理指標差異………………..50-52
第三節 研究對象的疲憊感受、睡眠品質、焦慮憂鬱及生活品質狀態..52-54
第四節 介入措施對疲憊感受、睡眠品質、焦慮及生活品質之影響…..54-81
第五節 研究對象接受介入措施前後之主觀感受………………………..82





第五章…………………………………………………………………………83-88
第一節 研究對象基本資料與疾病屬性………………………………….83
第二節 研究對象的疲憊感受、睡眠品質、焦慮及生活品質之狀態….84-85
第三節 介入措施對疲憊感受、睡眠品質、焦慮及生活品質之影響….85-86
第四節 不同測量時間點之成效比較…………………………………..87-88
第六章 結論與建議………………………………………………………….89-91
第一節結論………………………………………………………………..89
第二節 建議……………………………………………………………….90
第三節 研究限制………………………………………………………….91

參考資料 ………………………………………………………………….. …91-99
中文部分…………………………………………………………………… 91-86
英文部分…………………………………………………………………… 87-91

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