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研究生:汪玉珍
研究生(外文):Yu Jen Wang
論文名稱:極低出生體重早產兒童的動作功能及健康相關生活品質
論文名稱(外文):Motor Functions and Health-related Quality of Life in Preterm Very Low-birth-weight Children
指導教授:劉文瑜劉文瑜引用關係
指導教授(外文):W. Y. Liu
學位類別:碩士
校院名稱:長庚大學
系所名稱:復健科學研究所
學門:醫藥衛生學門
學類:復健醫學學類
論文種類:學術論文
論文出版年:2009
畢業學年度:97
論文頁數:128
中文關鍵詞:極低出生體重動作功能健康相關生活品質
外文關鍵詞:Very Low-birth-weightmotor functionhealth-related quality of life
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背景與目的:隨著存活率的提升,極低出生體重(very-low-birth-weight, VLBW)早產兒童的預後也逐漸受到重視,而過去文獻指出VLBW早產兒童的動作功能與健康相關生活品質(health-related quality of life, HRQL)相較於正常出生體重足月兒童是較低的。然而過去所探討之VLBW早產兒童族群多包含有預後較差的超低出生體重兒童(extremely low birth weight, ELBW)或是已有發展遲緩相關診斷之兒童,對於無發展遲緩相關診斷之兒童是否同樣存有較差的動作功能以及HRQL的討論則有限,因此本研究的目的為探討無發展相關診斷,但出生時有早產及VLBW歷史之五至七歲兒童的動作功能與健康相關生活品質,並分析比較出生體重配對之出生為體重過輕(small for gestational age, SGA)以及適當出生體重(appropriate for gestational age, AGA)之早產兒童的表現差異。方法:採橫斷面研究設計,本研究徵召年齡介於五至七歲的兒童以及他們的家長,共分為兩組兒童分別是(1)20位足月產兒童(以下稱為足月控制組)及(2)25名無發展遲緩相關診斷之VLBW早產兒童(以下統稱為VLBW組),其中又可細分為16位出生時為AGA (以下簡稱VLBW-AGA)兒童及9位出生為SGA (以下簡稱VLBW-SGA)兒童。所有的兒童皆接受布魯茵克斯-歐西瑞斯基動作精練度評量工具第二版(Bruininks-Oseretsky test of motor proficiency second edition, BOT-2)的動作功能評估,且由家長們填寫子女健康問卷-家長版50(Child Health Questionnaire-Parent Form 50, CHQ-PF50)做為HRQL的評估。使用描述性統計、獨立t檢定以及卡方檢定等分析探討組別之間是否存在差異。結果:兩組兒童在CHQ-PF50的分數是無差異存在,但BOT-2的評量結果顯示,VLBW組兒童的整體動作表現顯著低於足月控制組兒童(p=0.000)。若進一步比較出生體重相配對之AGA與SGA兩組兒童與足月兒童之整體動作表現,結果顯示三組間存有顯著性的差異(p=0.034),且VLBW-AGA的表現是顯著性地低於足月兒童。討論:本研究顯示雖然依據家長回答,VLBW組與足月控制組兒童的HRQL並無顯著差異,但根據標準化動作評估結果顯示五至七歲的VLBW組兒童的動作功能仍明顯低於足月控制組,其中又以出生懷孕周數較低之AGA兒童的表現最為顯著。依據以上的結果,家長自填HRQL問卷未必能夠有效地判別無明顯發展遲緩相關診斷之VLBW兒童所存在的可能動作障礙,建議未來在VLBW兒童的出院照顧計畫中,特別是出生懷孕周數較低之AGA兒童部分,需強化家長對於兒童的動作功能發展的瞭解,並配合持續穩定地發展追蹤,以期能早期發現有動作障礙的兒童並盡早提供合適的介入。
Background and Purpose: With the survival rate of low-birth-weight children now increasing, the prognosis of preterm very-low-birth-weight (VLBW) children is gradually being examined more closely. According to previous studies, VLBW children exhibit poor motor function performance and a poorer health-related quality of life (HRQL) as compared with full-term, normal-birth-weight children; however, the study populations in these previous studies have comprised extremely-low-birth-weight (ELBW) children with poor prognoses and VLBW children with a specific diagnosis such as developmental delay, and it is not known whether children without a specific diagnosis of developmental delay show the same levels of movement performance. The purpose of this study was to investigate whether differences exist in terms of motor function and HRQL between VLBW children with no specific diagnosis of developmental delay and full-term children. Therefore, we compared test results for birth-body-weight-matched appropriate-for-gestational-age (AGA) children, and small-for-gestational-age (SGA) children with those of full-term children. Method: 5–7-year-old children and their parents were recruited to the study, which was of a cross-sectional design, and subjects were divided into (1) full-term children (n=20) and (2) VLBW children (n=25), the latter group including 16 AGA children and 9 SGA children. All children were administered the Bruininks-Oseretsky test of motor proficiency second edition (BOT-2), and the Child Health Questionnaire-Parent Form 50 (CHQ-PF50) was completed by the parents for HRQL analysis. Descriptive statistics, independent t-tests and chi-square calculations were used to identify the differences in motor function and HRQL between groups. Results: There were no significant differences between the VLBW children and full-term children in terms of CHQ-PF50, while the VLBW children achieved poor motor performance (p=0.000) as assessed by the BOT-2. Moreover, there were significant differences between the three groups in total motor composite (p=0.034) of BOT-2 and the post hoc test, the AGA children achieving significantly lower scores than the full-term children. Discussion: There was no significant difference in HRQL between groups as reported by the parents, but VLBW children exhibited poor motor function (especially those in the AGA group) according to the results of a standard assessment tool. According to the results, HRQL as reported by the parents is unlikely to indicate motor function deficit in VLBW children. It was recommend that discharge plans for VLBW children, especially AGA children, should place more emphasis on parents’ recognition of their children’s motor function development and regularly follow-up the motor function prognosis of VLBW children in order to improve the early detection of motor deficit in VLBW children and enable appropriate intervention.
指導教授推薦書………………………………………………..………ii
口試委員審定書……………………………………………………......iii
國家圖書館授權書……………………………………………………..iv
長庚大學授權書……………………………………………………….. v
致謝…………………………………………………………………..…vi
中文摘要……………………………………………………………….viii
英文摘要………………………………………………………………...x
目錄……………………………………………………………………..xii
第一章 緒論 …………………………………………………………01
1.1 研究背景與動機………………………………………………..01
1.2 研究目的………………………………………………………..04
1.3 研究假設……………………………………………………..…05
1.4名詞解釋………………………………………………………...06
第二章 文獻回顧 ……………………………………………………..10
2.1 簡介……………………………………………………………..10
2.2 無發展遲緩相關診斷之極低出生體重(VLBW)早產兒童的結果量測………..……………………………………………………...…10
2.2.1無發展遲緩相關診斷之VLBW早產兒童的動作功能……………………………………………………………….....11
2.2.1.1 動作功能評估工具………………………………….…19
2.2.2 無發展遲緩相關診斷之VLBW早產兒童的健康相關生活品質......................................................................................................22
2.2.2.1 健康相關生活品質評估工具……………………….…27
2.3 無發展遲緩相關診斷之VLBW早產兒童的動作功能與健康相關生活品質之影響因子……………………………………….30
第三章 研究方法..……………………………………………………34
3.1 研究對象...………………………………………………….…..34
3.2 研究工具及使用目的……………………………..………..…..35
3.3 研究步驟……………………………………………………......39
3.4 統計分析……………………………………………………......40
第四章 結果……………………………………………………………46
4.1無發展遲緩相關診斷之極低出生體重(VLBW)早產兒童組與足月控制組兒童的動作功能…………………………………………46
4.2 VLBW-AGA與足月AGA組兒童的動作功能..……..……….46
4.3無發展遲緩相關診斷之VLBW組與足月控制組兒童的HRQL………….…..………………………………………………...47
4.4 VLBW-AGA與足月AGA兒童的HRQL………………............47
4.5出生體重配對VLBW-SGA、VLBW-AGA兒童與足月AGA兒童的動作功能與HRQL……………………………...……………...47
4.6其他影響動作功能與健康相關生活品質因子…………………48
第五章 討論
5.1 無發展遲緩相關診斷之VLBW早產兒童的動作功能…………………………………………………………….………67
5.2 無發展遲緩相關診斷之VLBW早產兒童的健康相關生活品質…………………………………………………………….………70
5.3無發展遲緩相關診斷之兒童的動作功能與健康相關生活品質之影響因子…………………………………………………………….72
5.3.1 動作功能…………………………………………………....72
5.3.2 HRQL……………………………………………..………....72
5.3.3動作功能與HRQL…………..……………………………....73
5.4 臨床意義…………………………………..…………………....74
第六章 結論……………………………………………………………75
圖表目錄……………………………………………………….…….…xv
參考文獻………………………………………………………………..76
附錄…………………………………………………………………….,86

圖3.1 實驗流程圖……………………………………………………...45
表2.1 曾住過新生兒加護病房之兒童住院時期之健康狀況………...32
表2.2 三種動作評估工具之優缺點…………...………………………33
表3.1 VLBW兒童與足月控制組兒童的基本資料………..………….43
表3.2 VLBW-AGA兒童與足月-AGA控制組兒童的基本資料……...44
表4.1 VLBW組與足月控制組兒童的BOT-2分數比較表…………..50
表4.2 VLBW組與足月控制組兒童的 BOT-2結果描述類別……….52
表4.3 VLBW-AGA兒童與足月-AGA組兒童的BOT-2分數比較表..54
表4.4 VLBW-AGA與足月-AGA組兒童的 BOT-2結果描述類別…..56
表4.5 VLBW組與足月控制組兒童的HRQL…………………………58
表4.6 VLBW-AGA與足月-AGA組兒童的HRQL……………………59
表4.7 出生體重配對的VLBW-AGA、VLBW-SGA與足月-AGA組兒童的BOT-2分數…………………………………………………60
表4.8 VLBW-AGA、VLBW-SGA與足月-AGA組的CHQ-PF50……62
表4.9其他影響動作功能因子…………………………………………63
表4.10其他影響健康相關生活品質因子……………..………………64
表4.11 BOT-2與健康相關生活品質相關性…………………………..65
附表1.1 本研究的BOT-2施測者之施測再測信度…………………..87
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