臺灣博碩士論文加值系統

中文摘要
本研究主要目的為探討化學治療期間肺癌病患睡眠之變化及影響因素。研究採縱貫性設計，收取82位肺癌個案，於化療的前一天至化療後28天期間由病患自行記錄睡眠日誌。應用描述性統計、重複測量變異數分析與混合模式統計方法資料分析。
研究結果發現(1) 化療期間肺癌病患之睡眠參數於化療後第一週上升，第三週逐漸下降接近化療前，第四週又逐漸上升且疲憊感達最高；化療後平均睡眠潛伏期為38.70分；睡眠中斷時間為54.70分；中斷次數為2.45次；總睡眠時間為436.63分；睡眠效率為83.18%；小睡時間為91.53分；小睡次數為1.28次。(2) 7項睡眠參數中，時間主效應於睡眠中斷時間達顯著意義；其它除總睡眠時間外，在時間趨勢上均呈現顯著三次方的趨勢，即在趨勢圖上有二個轉折點。(3) 人口學與治療特性中吸煙、工作、宗教、收入、治療場所、長期用藥與時間交互作用分別於睡眠中斷次數、總睡眠時間、小睡時間與次數之影響達顯著意義。(4) 主效應達顯著意義參數，年長者之睡眠中斷時間、次數、小睡時間與次數多於年輕者。高教育程度者之總睡眠時間多於初教育者。無工作者之小睡時間與次數多於有工作者。有信仰者之潛伏期少於無信仰。初次化療者之總睡眠時間少於曾經化療者。
關鍵字：化學治療，睡眠之變化，肺癌

Abstract

The purpose of this study was to explore the change of sleep parameters and related factors for among patients with lung cancer receiving chemotherapy. A sample of 82 patients with lung cancer completed this longitudinal study. Patients completed sleep diary for one day prior to and during the 28-day. Data were analyzed using descriptive statistics, repeated measures and Mixed Models.
The study result show (1). Patients experienced a rise in sleep patterns during the first week of chemotherapy. Their patterns gradually declined, and then went back to the situation as pre-chemotherapy in the third week. After, receiving 4 week cycles of chemotherapy, their sleep patterns gradually rised, and patients experienced high levels of fatigue. After chemotherapy the mean for the following variables are: sleep latency was 37.80 minutes, duration of wakefulness was 54.70 minutes, number of awakenings was 2.45 times, sleep duration was 436.63 minutes, sleep efficiency was 83.18%, day time sleep was 91.53 minutes, number of napping was 1.28 times. (2). Among seven sleeping patterns, only duration of wakefulness reaches the significant level on the main effects of time. The trends on sleep parameters show significant except sleep duration. (3). Demographic and treatment characteristics, significant interaction effects were found between time and smoke, work, religion, income, place, drugs used on number of awakenings, sleep duration, daytime sleep and number of napping. (4). Age is a significant main effect on duration of wakefulness, number of awakenings, daytime sleep and number of napping, the older the more frequent. Education is a significant main effect on sleep duration, the more education the longer. Work Status was a significant main effect on daytime sleep, number of napping, patients without jobs slept more higher. There was a significant main effect of religion on sleep latency, People who had religion had less sleep latency. There was a significant main effect of cycle of treatment on sleep duration, patients who received the second chemotherapy have longer sleep duration.
Key words: Chemotherapy, Change of sleep parameters, Lung cancer

目錄
頁數
指導教授推薦書………………………………………
論文口試委員會審定…………………………………
長庚大學授權書………………………………………iii
致謝……………………………………………………iv
中文摘要………………………………………………v
英文摘要………………………………………………vi
第一章 緒論…………………………………………1
第一節 研究動機與重要性……………………1
第二節 研究目的………………………………4
第三節 研究問題………………………………4
第二章 文獻查證……………………………………5
第一節 肺癌及其相關治療……………………5
第二節 睡眠之概念……………………………13
第三節 癌症病患化學治療期間睡眠之變化………24
第四節 文獻總結………………………………25
第三章 研究方法……………………………………26
第一節 研究架構………………………………26
第二節 研究設計………………………………27
第三節 研究場所及對象………………………28
第四節 研究工具………………………………29
第五節 資料收集過程…………………………34
第六節 資料分析………………………………37
第四章 研究結果與分析………………………………38
第一節 肺癌病患的人口學、疾病與治療特性之描
述性分析………………………………………………39
第二節 化學治療期間肺癌病患睡眠之變化…45
第三節 人口學、疾病、治療特性與時間對於睡眠參
數之影響………………………………57
第五章 討論…………………………………………79
第一節 化學治療期間睡眠之變化……………79
第二節 人口學特性、疾病特性、治療特性與時間
對於睡眠型態之影響…………………85
第六章 結論與建議…………………………………90
第一節 結論……………………………………90
第二節 護理的應用……………………………92
第三節 研究限制與建議………………………93
參考文獻 ………………………………………………94
中文部分…………………………………………………94
英文部分…………………………………………………96
附錄………………………………………………………104




圖表目錄
圖次 頁數
圖 3-1 研究架構……………………………………26
圖 3-2 收案流程圖…………………………………36
圖 4-1 睡眠潛伏期之變化圖………………………48
圖 4-2 睡眠中斷時間變化圖………………………48
圖 4-3 睡眠中斷次數變化圖………………………49
圖 4-4 總睡眠時數變化圖…………………………49
圖 4-5 睡眠效率變化圖……………………………50
圖 4-6 小睡時間變化圖……………………………50
圖 4-7 小睡次數變化圖……………………………51
圖 4-8 醒後疲憊感變化圖 …………………………51
圖 4-9 宗教信仰主效應於睡眠潛伏期趨勢圖……68
圖 4-10 年齡主效應於睡眠中斷時間趨勢圖………69
圖 4-11 宗教信仰與時間交互作用對於睡眠中斷次數趨勢圖……70
圖 4-12 年齡主效於睡眠中斷次數趨勢圖…………………………70
圖 4-13 宗教信仰與時間交互作用對於總睡眠時間趨勢圖………71
圖 4-14 長期用藥與時間交互作用對於總睡眠時間趨勢圖………72
圖 4-15 教育程度主效應於總睡眠時間趨勢圖……………………73
圖 4-16 化學療程主效應於總睡眠時間趨勢圖……………………73
圖 4-17 吸煙與時間交互作用對於小睡時間趨勢圖………………74
圖 4-18 工作與時間交互作用對於小睡時間趨勢圖………………75
圖 4-19 收入與時間交互作用對於小睡時間趨勢圖………………76
圖 4-20 年齡主效應於小睡時間趨勢圖……………………………76
圖 4-21 治療場所與時間交互作用對於小睡次數趨勢圖…………77
圖 4-22 年齡主效應於小睡次數趨勢圖……………………………78
圖 4-23 工作狀況主效應於小睡次數趨勢圖………………………78




表次目錄
表次 頁數
表3-1 統計分析法………………………………………………………37
表4-1 肺癌患者之人口學屬性…………………………………………40
表4-2 肺癌患者之疾病特性……………………………………………43
表4-3 肺癌患者之治療特性……………………………………………44
表4-4 化療期間各時間點睡眠參數值之表現…………………………46
表4-5 病患自覺夜間睡眠干擾因子……………………………………52
表4-6 病患自覺白天干擾因子…………………………………………54
表4-7 化學治療期間各個時間點上睡眠參數之變化…………………56
表4-8 人口學、疾病、治療特性與時間對於睡眠參
數的影響…………………………………………………………59
表4-9 影響睡眠參數之相關變項:混合模式分析………………………67
表4-10 宗教信仰與時間交互作用對於睡眠中斷次數的結果…………70
表4-11 宗教信仰與時間交互作用對於總睡眠時間的結果……………71
表4-12 長期用藥與時間交互作用對於總睡眠時間的結果……………72
表4-13 吸煙狀況與時間交互作用對於小睡時間的結果………………74
表4-14 工作狀況與時間交互作用對於小睡時間的結果………………75
表4-15 收入狀況與時間交互作用對於小睡時間的結果………………76
表4-16 治療場所與時間交互作用對於小睡次數的結果………………77






附錄目錄
頁數
附錄一 病患基本資料表……………………………………104
附錄二 睡眠日誌……………………………………………109
附錄三 專家效度意見與評分………………………………112
附錄四 睡眠日誌專家效度評………………………………119
附錄五 睡眠日誌表面效度評分……………………………121
附錄六 受試者同意書………………………………………123
附錄七 資料收取流程圖……………………………………125
附錄八 研究對象中途退出之時間點與原因………………126

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