臺灣博碩士論文加值系統

本研究探討肺癌病人化學治療期間疼痛、憂鬱與睡眠品質的關係及變化。研究採縱貫性設計，共收取116位肺癌病人，由化療前至化療第六療程，每個療程的第15日填寫簡明疼痛評估量表、醫院焦慮憂鬱量表、匹茲堡睡眠品質量表，了解整個化學治療期間的變化。統計採用描述性統計、皮爾森相關與混合模式等方法進行資料分析。
研究結果顯示，(1)疼痛平均程度化療前至第六療程介於輕度疼痛，整個療程呈現上下波動，六個療程的強度均比化療前低。(2)大部份病人沒有憂鬱情形，化療前的憂鬱分數最高，隨療程憂鬱程度逐漸下降；化療前及第ㄧ療程憂鬱程度顯著大於其他療程。(3)睡眠品質在無化療時於第ㄧ療程最差，第三療程改善，第四至第六療程呈現上下波動情形。在化療時，睡眠品質則由第二療程持續惡化至第五療程，統計顯示無化療時，在化療前及第ㄧ療程睡眠品質顯著比其他療程差。(4)平均疼痛程度，於第四療程、第六療程與睡眠品質達顯著相關。憂鬱程度，在七個時間點與睡眠品質均達顯著正相關。(5)收入對睡眠品質有顯著影響，無收入者的睡眠品質較有收入者差。(6)化療時，化療藥物與時間有交互作用，使用傳統藥物者其睡眠品質有惡化趨勢，而使用非傳統藥物者則有改善趨勢。

The purpose of this study was to explore the longitudinal change in and relationship among pain, depression, and sleep quality in lung cancer patients treated with chemotherapy. A total of 116 patients with lung cancer were recruited. Patients completed Brief Pain Inventory (BPI, Hospital Anxiety and Depression Scale(HADS), and Pittsburgh Sleep Quality Index (PSQI) at pre-chemotherapy and at the 15th day of every chemotherapy cycle for 6 cycles. Data were analyzed using descriptive statistic, Pearson correlation and mixed effect models.
The study results showed: (1) the average pain levels were mild through out six chemotherapy cycles with pre-chemotherapy level being the highest. (2) Most of the patients were not depressed through out six chemotherapy cycles. Depressive scores were high at pre-chemotherapy but gradually decreased through out the chemotherapy cycles. Depressive scores at pre-chemotherapy and the 1st cycles were significantly higher than other cycles. (3) During days when chemotherapy was given, sleep quality were continuously worsen from the 2nd to the 5th cycles. During days when chemotherapy was not given (rest period), sleep quality was poor at the 1st cycle and improved at the 2nd and 3rd cycle, then fluctuated at the 4th and 6th cycles; the sleep quality at pre-chemotherapy and the 1st cycle was significantly poorer than that of other cycles. (4) Significant correlations were found between average pain level and sleep quality at the 4th and 6th cycles and between depression and sleep quality at all cycles. (5) Income had significant effect on sleep quality; patients with low income had poorer sleep quality. (6) During days when chemotherapy was given, there was a significant interaction effect on sleep quality between type of chemotherapy agent and time. The sleep quality for patients treated with traditional chemotherapy agents was deteriorate over time; but for patients treated with new drugs (e.g., target therapy), the sleep quality tended to improve over time.

指導教授推薦書……………………………………………………
論文口試委員會審定書……………………………………………
長庚大學授權書……………………………………………………
誌謝…………………………………………………………………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………………………………………………5
第三節 研究問題………………………………………………5
第四節 名詞解釋………………………………………………6
第二章 文獻查證………………………………………………7
第一節 肺癌相關概念……………………………………7
第二節 睡眠品質相關概述…………………………………12
第三節 疼痛與睡眠品質相關之研究………………………22
第四節 憂鬱與睡眠品質相關之研究……………………………28
第五節 總結………………………………………………………33
第三章 研究方法………………………………………………34
第一節 概念架構……………………………………………34
第二節 研究設計…………………………………………………35
第三節 研究場所與對象…………………………………………35
第四節 研究工具…………………………………………………36
第五節 資料收集過程……………………………………………40
第六節 資料分析…………………………………………………42
第七節 樣本數預估………………………………………………43
第八節 研究對象之權益保護……………………………………43
第四章 研究結果與分析…………………………………………44
第一節 肺癌病人的人口學、疾病與治療特性之描述性
分析……………………………………………………………………55
第二節 肺癌病人疼痛、憂鬱與睡眠品質之變化………………65
第三節 肺癌病人睡眠品質與疼痛、憂鬱之關係………………68
第四節 人口學、疾病、治療特性與時間對於睡眠品質
之影響…………………………………………………………………70
第五章 討論………………………………………………………75
第一節 疼痛、憂鬱、睡眠品質表現及變化情形………………75
第二節 疼痛、憂鬱與睡眠品質的相關性………………………79
第三節 人口學、疾病、治療特性與時間對於睡眠品質
之影響…………………………………………………………………81
第六章 結論與建議………………………………………………83
第一節 結論………………………………………………………83
第二節 護理的應用………………………………………………84
第三節 研究限制與建議…………………………………………85
參考資料………………………………………………………………87
中文部分………………………………………………………87
英文部分………………………………………………………92
附錄……………………………………………………………………102

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