臺灣博碩士論文加值系統

背景：癌症病人於接受化療後引致噁心、嘔吐是最常見的不適症狀。副交感神經活化可藉由測量心率變異參數得知。噁心嘔吐與胃肌電波活動及心率變異間之關係仍待確認。
目的：比較癌症兒童接受化療前、中、後的胃肌電波活動與心率變異參數之差異。
方法：本研究為重複施測之比較性研究。採方便取樣，四個月期間，共有九位平均年齡為12.7歲的癌症兒童參與研究。病童接受化療期間(Day1、Day4、Day7)於早餐前禁食六小時後，飲水150㏄前後，分別以胃肌電監測儀(Synectics Medical, USA)及心率變異測量儀(Biocom, USA)，測量病童飲水前後各30分鐘之胃肌電波活動參數與心率變異參數。以Paired t-test或Wilcoxon test for paired observations檢測病童飲水前後之變化，Repeated measures ANOVA或Friedman two-way analysis of variance by rank檢測病童化療期間之胃肌電波活動參數與心率變異參數之差異。
結果：一、癌症兒童於飲水後之胃正常慢波百分比(%SW)，於化療期間有顯著的差異(X2 = 6.276, p = .045)。二、化療前(Day1)，癌症兒童飲水後之胃正常慢波百分比較飲水前高(z = -2.666, p = .008)；而化療中(Day4)及化療後(Day7)飲水前後沒有統計學上顯著差異。而化療中(Day4)，癌症兒童飲水後之胃波過快百分比較飲水前少(z = -1.992, p = .046)。三、癌症兒童於飲水後之心率變異參數--高頻，於化療期間有顯著的差異(X2 = 11.556, p = .003)，即化療後(Day7)之高頻低於化療前(Day1) (z = -2.666, p = .008)。化療後(Day7)，癌症兒童飲水後之高頻較飲水前低(z = -2.192, p = .028)。
結論：在化療期間，癌症兒童之胃肌電波活動與心率變異參數有顯著差異，尤其在化療後，且胃肌電波活動參數與心率變異參數可以為護理研究發展可行之實證的生理指標，促進實證護理的發展數據，提升臨床以實證為基礎之照護。

Background: Symptoms of nausea and vomiting are suffered in cancer patient receiving chemotherapy. Parasympathetic activity could be measured by the parameters of heart rate variability (HRV). The relationships among nausea/vomiting, gastric myoelectrical activity, and HRV need to be identified.
Purposes: The purpose of this study was to compare the differences of parameters of electrogastrography (EGG) and HRV during chemotherapy in children with cancer.
Methods: A repeated measures comparative study was conducted. Conveniently nine children with cancer (mean age: 12.7 years old) were recruited in this study during four-month period. The differences of parameters of EGG and HRV were compared pre- and post-water intake after fasting at least six hours in the morning during the period of receiving chemotherapy, ie., Day1, Day4, and Day7. EGG was recorded using non-invasive Digitrapper Electrogastrography (Synectics Medical, USA). HRV was measured by Biocom Heart Rhythm Scanner 2.0 (Biocom, USA). EGG and HRV were recorded simultaneously for 30 min pre- and post-150ml water intake. The differences of parameters of EGG and HRV were examined by repeated measures ANOVA or Friedman two-way analysis of variance by rank during the period of receiving chemotherapy. The differences of parameters of EGG and HRV parameters pre- and post-water intake were examined by Paired t-test or Wilcoxon test for paired observations.
Results: There was a significant difference on the percentage of 2-4cpm slow waves after water intake during chemotherapy (X2 = 6.276, p = .045). After water intake, a significant higher the percentage of 2-4cpm slow waves on Day1 (z = -2.666, p = .008), not Day4 and Day7. On Day4, a significant lower percentage of tachygastria on pre- water intake than after (z = -1.992, p = .046). After water intake, there was a significant difference on parameter of High Frequency (HF) during chemotherapy (X2 = 11.556, p = .003). It means the HF of HRV on Day7 was significant lower than on Day1 (z = -2.666, p = .008). There was a significant lower HF after water intake than before on Day7 (z = -2.192, p = .028). Conclusion: There was significant change over chemotherapy on parameters of EGG and HRV in children with cancer. For evidence based practice, the parameters of EGG and HRV can be used as physiological indicators in clinical nursing research.

中文摘要………………………………………… i-ii
英文摘要……………………………………………iii- iv
誌謝………………………………………………… v-vii
論文目錄……………………………………………viii-x
圖目錄……………………………………………… xi-xii
表目錄………………………………………………… xiii

第一章 緒論……………………………………………1-2
第一節 研究動機與重要性……………………………1-2
第二節 研究目的…………………………………………2

第二章 文獻查證………………………………………3-15
第一節 生理�琠w與化療引致之噁心、嘔吐之關係…3-5
第二節 腸胃道的神經支配……………………………5-7
第三節 腸胃平滑肌之電位活動與胃電圖之原理及應
用………………………………………………7-9
第四節 副交感神經活化與心率變異的關係…………10-11
第五節 胃蠕動的機制、胃肌電波活動與心率變異的關
係………………………………………………11-12
第六節 影響自主神經系統對腸胃道調控之相關因
素………………………………………………12-13
第七節 化療對副交感神經活化的影響………………13-14
第八節 化療藥物對胃肌電波的影響…………………14-15

第三章 概念架構與研究架構………………………16-22
第一節 概念架構……………………………………16-17
第二節 研究架構……………………………………17-19
第三節 名詞界定……………………………………19-21
第四節 研究問題與研究假設………………………21-22

第四章 研究方法……………………………………23-35
第一節 研究對象與場所……………………………23-24
第二節 研究工具……………………………………24-30
第三節 資料收集過程………………………………30-32
第四節 資料分析方法………………………………33-34
第五節 資料收集員訓練……………………………34
第六節 研究對象之倫理考量………………………34-35

第五章 研究結果……………………………………36-78
第一節 研究對象之樣本特性………………………36-48
第二節 飲水前，化療期間之胃肌電波活動與心率變異的
關係…………………………………………48-52
第三節 飲水後，化療期間之胃肌電波活動與心率變異的
關係…………………………………………53-58
第四節 化療期間之心率變異參數rHF比值的變化……59
第五節 化療期間之胃肌電波活動參數胃肌電功率比值的
變化…………………………………………59-60
第六節 胃肌電波活動與心率變異參數在飲水前後之差
異……………………………………………60-69
第七節 化療後(Day7)有噁心癌症兒童之胃肌電波活動與
心率變異的關係……………………………69-74
第八節 化療後(Day7)無噁心癌症兒童之胃肌電波活動與
心率變異的關係……………………………74-78

第六章 討論…………………………………………79-84
第一節 化療期間胃肌電波活動參數之變化………79-80
第二節 化療期間心率變異參數之變化……………80-81
第三節 化療後有無噁心癌症兒童之胃肌電波活動參數之
變化…………………………………………81-83
第四節 化療後有無噁心癌症兒童之心率變異參數之變
化……………………………………………83-84

第七章 結論…………………………………………85-89
參考資料……………………………………………90-102
附件一 個案基本資料表…………………………103-104
附件二 病童自填噁心嘔吐量表………………………105
附件三 人體試驗委員會同意臨床試驗證明書………106
附件四 臨床試驗說明及同意書（小孩）………107-108
附件五 臨床試驗說明及同意書（法定代理人）109-110

圖目錄
圖3-1-1化療生理恆定概念架構………………………17
圖3-2-1研究架構………………………………………19
圖4-1-1胃肌電波監測儀測量時電極片黏貼位置圖…25
圖4-2-1研究流程………………………………………32
圖5-1-1收案結果………………………………………36
圖5-1-2.癌症兒童於化療期間(Day1、Day4、及Day7)之修
正羅氏噁心嘔吐量表得分…………………44
圖5-1-3癌症兒童於化療期間(Day1、Day4、及Day7)之噁
心次量表得分…………………………………45
圖5-1-4癌症兒童於化療期間(Day1、Day4、及Day7)之嘔
吐次量表得分…………………………………46
圖5-1-5病童於化療前(Day1)每隔五分鐘心跳速率之變
化………………………………………………47
圖5-1-6病童於化療中(Day4)每隔五分鐘心跳速率之變
化………………………………………………47
圖5-1-7病童於化療後(Day7)每隔五分鐘心跳速率之變
化………………………………………………48
圖5-2-1癌症兒童飲水前，低頻/高頻功率比值在化療期間
之變化…………………………………………52
圖5-3-1癌症兒童飲水後，胃正常慢波百分比在化療期間
之變化…………………………………………56
圖5-3-2癌症兒童飲水後，胃波過快百分比在化療期間之
變化……………………………………………56
圖5-3-3癌症兒童飲水後，在化療期間心率變異參數高頻
之變化…………………………………………58
圖5-6-1癌症兒童化療期間胃肌電頻率在飲水前後之差
異………………………………………………61
圖5-6-2癌症兒童化療期間胃肌電功率在飲水前後之差
異………………………………………………63
圖5-6-3癌症兒童化療期間胃正常慢波百分比在飲水前後
之差異…………………………………………64
圖5-6-4癌症兒童化療期間胃波過快百分比在飲水前後之
差異……………………………………………66
圖5-6-5癌症兒童化療期間心率變異之高頻在飲水前後之
差異……………………………………………68
圖5-6-6癌症兒童化療期間心率變異之低頻/高頻功率比值
在飲水前後之差異……………………………69
圖5-7-1化療後有噁心癌症兒童胃肌電功率在飲水前後之
差異……………………………………………71
圖5-7-2化療後有噁心癌症兒童胃肌電頻率在飲水前後之
差異……………………………………………71
圖5-7-3化療後有噁心癌症兒童胃正常慢波百分比在飲水
前後之差異……………………………………72
圖5-7-4化療後有噁心癌症兒童胃快波百分比在飲水前後
之差異…………………………………………72
圖5-7-5化療後有噁心癌症兒童高頻在飲水前後之差
異………………………………………………73
圖5-7-6化療後有噁心癌症兒童低頻/高頻功率比值在飲水
前後之差異………………………………… 74
圖5-8-1化療後無噁心癌症兒童胃肌電頻率在飲水前後之
差異……………………………………………75
圖5-8-2化療後無噁心癌症兒童胃肌電功率在飲水前後之
差異……………………………………………75
圖5-8-3化療後無噁心癌症兒童胃正常慢波百分比在飲水
前後之差異……………………………………76
圖5-8-4化療後無噁心癌症兒童胃波過快百分比在飲水前
後之差異………………………………………76
圖5-8-5化療後無噁心癌症兒童之高頻在飲水前後之差
異………………………………………………77
圖5-8-6化療後無噁心癌症兒童低頻/高頻功率比值在飲水
前後之差異……………………………………78

表目錄
表4-2-1心電圖監測器測得之心跳速率與心率變異監測儀
測得之脈搏速率的關係………………………28
表5-1-1人口學基本資料………………………………38
表5-1-2病童所接受的化療藥物………………………40
表5-1-3化療藥物催吐性分類規則……………………42
表5-1-4化療藥物之催吐性……………………………42
表5-1-5止吐藥種類……………………………………43
表5-2-1癌症兒童飲水前，胃肌電波活動參數在化療期間
之變化…………………………………………50
表5-2-2癌症兒童飲水前，心率變異參數在化療期間之變
化………………………………………………52
表5-3-1癌症兒童飲水後，胃肌電波活動參數在化療期間
之變化…………………………………………55
表5-3-2癌症兒童飲水後，心率變異參數在化療期間之變
化………………………………………………58
表5-4-1癌症兒童之心率變異參數rHF比值在化療期間之變
化………………………………………………59
表5-5-1癌症兒童之胃肌電波活動參數胃肌電功率比值在
化療期間之變化………………………………60
表7-1-1比較化療期間，癌症兒童的胃肌電波活動與心率
變異參數變化的研究結果彙整總表…………86

中華民國兒童癌症基金會•(2004)•至92.12中華民國兒童癌症基金會(2004)•中華民國兒童癌症基金會會訊，83，41。
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陳高揚、郭正典、駱惠銘（2000）．心率變異度：原理與應用．中華民國急救加護醫學會雜誌，11（2），47-58。
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袁宗凡•(2000b)•腸胃生理學•於林佑穗、袁宗凡譯•新編蓋統醫用生理學(pp. 845-851)•台北：合記。
駱麗華、戴臆珊、周雪菁•(2006) •兩位白血病病童之胃肌電波活動與噁心/嘔吐之初探•護理雜誌•53(1)，46-53。
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