臺灣博碩士論文加值系統

本研究在探討乳癌婦女手術後體重變化的情形以及個案基本屬性、疾病特性及輔助治療型態是否可預測術後十二個月內體重的變化。符合本研究收集標準之乳癌患者有200位，個案收案追蹤期間為民國94年7月14日至民國96年10月2日。病患於手術前一天填寫基本資料問卷及測量基準點體重與身體組成，於術後第1、2、3、4、5、6、8、10、12個月分別測量體重與身體組成，以階層線性模式（Hierarchical Linear Model，HLM）進行資料分析，以瞭解手術前後體重變化。
研究結果顯示乳癌病患手術後一年間體重呈現二次方的變化趨勢，體重隨時間先遞增，而後逐漸減低，呈現倒U的變化。乳癌病患年齡較大者在手術前的體重較重，且年齡較大者體重的起伏變化較小。已停經乳癌病患在手術後體重增加的幅度小於未停經的病患，在遞增後也未發生遞減，反而呈現輕微持續遞增現象。接受CMF者的體重會隨時間而明顯上升，至第八個月左右呈現逐月下降的趨勢，而接受CEF者的體重變化幅度較不明顯。
透過HLM單變項模式分析發現年齡、停經與化學藥物種類會影響體重的變化，將這三者一起放入HLM的多變項分析，則只有化學藥物達顯著水準，接受CMF與CEF者的體重變化顯著不同。
結論：乳癌手術後一年內體重變化隨著時間先遞增，而後逐漸減低，呈現倒U的變化，而輔助性化學藥物的種類對體重變化存在顯著的影響力。

The purpose of this study was to explore the dynamic change of body weight in breast cancer women one year after operation, and to determine whether the parameters including individual characteristics, disease characteristics and the regimens of adjuvant treatment could predict the body weight change during this period. A total of 200 patients with breast cancer were recruited in this study, and the data-collection period was from July 14th, 2005 to October 2, 2007. All patients filled demographic and disease/treatment information questionnaire before operation. Body weight was measured at pre-operation and 1, 2, 3, 4, 5, 6, 8, 10, 12 months after operation. Data were analyzed using Hierarchical Linear Model.
The results showed that the body weight change in breast cancer women during one year after operation demonstrated a quadratic trend, characterized by a progressive increase initially and then a gradual decrease. The overall change curve showed a reverse-U shape. The older patients had higher body weight at pre-operation, and the magnitude of their body weight change was smaller. The magnitude of body weight change of postmenopausal patients is smaller than that of premenopausal patients. Among the postmenopausal patients, their body weight did not demonstrate a decreasing change when reach the highest point as the overall pattern, instead it kept increasing slightly. Patients who treated with CMF had a remarkable body weight increase until 8 months after operation, and followed by a slowly decrease. However, the change of body weight in patients treated with CEF was not so appreciable. Through HLM univariate analysis, we found that age, menopausal status, and chemotherapy regimens could significantly affect the body weight change. However, chemotherapy regimen is the only one factor that could significantly affect the body weight change in multivariate analysis. Taken together, we conclude that the longitudinal change of post-operative body weight among breast cancer women is a reverse-U pattern with a progressive increase followed by a slowly decrease. Furthermore, the type of adjuvant chemotherapy is a remarkable factor that influences the change pattern of the post-operative body weight.

論文指導教授推薦書………………………………………………
論文口試委員會審定書……………………………………………
長庚大學碩士論文著作授權書……………………………………
誌謝………………………………………………………………iv
中文摘要………………………………………………………… v
英文摘要……………………………………………………… vii
目錄………………………………………………………………ix
論文目次……………………………………………………… x
表目錄……………………………………………………… xii
圖目錄……………………………………………………… xiv
附錄目錄…………………………………………………… xvi
［論文目次］
第一章 緒論
第一節 研究的動機與重要性……………………………………………1
第二節 研究目的與問題…………………………………………………4
第三節 名詞解釋…………………………………………………………4
第二章 文獻查證
第一節 乳癌病患體重改變的情形………………………………………6
第二節 乳癌病患體重改變的影響因素…………………………………8
第三章 研究方法
第一節 研究設計…………………………………………………………17
第二節 研究場所與對象…………………………………………………17
第三節 研究架構…………………………………………………………18
第四節 研究工具…………………………………………………………19
第五節 資料收集過程……………………………………………………22
第六節 資料統計與分析…………………………………………………24
第七節 樣本數估計………………………………………………………34
第四章 研究結果與分析
第一節 乳癌病患術後之個案基本屬性、疾病特性與輔助治療型態之描述分析……………………………………………………………35
第二節 乳癌病患體重之變化及其影響因素分析………………………39
第三節 乳癌病患體重變化之預測因子分析……………………………65
第五章 討論
第一節 癌婦女手術後十二個月內體重變化的情形……………………68
第二節 個案基本屬性、疾病特性及輔助治療型態是否可預測乳癌婦女手術後十二個月內體重的變化…………………………………70
第六章 結論與建議
第一節 結論………………………………………………………………76
第二節 護理上的應用……………………………………………………77
第三節 研究限制與建議…………………………………………………80
參考資料
中文部份…………………………………………………………………81
英文部分…………………………………………………………………82
［表目錄］
表3-1研究資料收集時間表………………………………………… 24
表 3-2 資料的統計與分析……………………………………………30
表 4-1乳癌病患個案基本屬性、疾病特性及輔助治療型態之分布…36
表 4-2 體重零模式結果摘要…………………………………………40
表 4-3 體重時間變化結果摘要………………………………………41
表4-4體重隨時間二次方變化結果摘要…………………………… 43
表4-5體脂肪百分比隨時間一次方變化結果摘要………………… 44
表4-6身體總水量百分比隨時間一次方變化結果摘要…………… 45
表4-7年齡與體重時間二次方變化結果摘要……………………… 47
表4-8停經狀況與體重時間二次方變化結果摘要………………… 49
表4-9規律運動與體重時間二次方變化結果摘要………………… 50
表4-10身體活動功能狀態與體重時間二次方變化結果摘要………51
表4-11手術方式與體重時間二次方變化結果摘要…………………53
表4-12淋巴結感染與體重時間二次方變化結果摘要………………54
表4-13癌症分期與體重時間二次方變化結果摘要…………………56
表4-14動情素接受體與體重時間二次方變化結果摘要……………57
表4-15有無輔助治療與體重時間二次方變化結果摘要……………59
表4-16有無使用類固醇與體重時間二次方變化結果摘要…………60
表4-17有無使用CEF與體重時間二次方變化結果摘要……………62
表4-18體重顯著相關因子總表………………………………………64
表4-19 停經狀態與化學藥物種類交叉表……………………………65
表4-20年齡與停經、化學藥物的種類之關係………………………65
表4-21預測因子之多變項分析………………………………………66
［圖目錄］
圖3-1乳癌婦女手術後體重變化研究架構 …………………………18
圖3-2收案流程圖 ……………………………………………………23
圖4-1乳癌病患手術後十二個月內的體重變化圖 …………………41
圖4-2乳癌病患手術後十二個月時間二次方體重變化圖 …………43
圖4-3乳癌病患手術後十二個月內的體脂肪百分比變化圖 ………45
圖4-4乳癌病患手術後十二個月內的身體總水量百分比變化圖 …46
圖4-5乳癌病患手術後十二個月內年齡與體重變化的關係圖 ……48
圖4-6乳癌病患手術後十二個月內停經狀態與體重變化的關係圖 49
圖4-7乳癌病患手術後十二個月內規律運動與體重變化的關係圖 51
圖4-8乳癌病患手術後十二個月內身體活動功能狀態與體重變化的關係圖…………………………………………………………52
圖4-9乳癌病患手術後十二個月內手術方式與體重變化的關係圖………………………………………………………………54
圖4-10乳癌病患手術後十二個月內淋巴結感染與體重變化的關係圖………………………………………………………………55
圖4-11乳癌病患手術後十二個月內癌症分期與體重變化的關係圖………………………………………………………………56
圖4-12乳癌病患手術後十二個月內動情素接受體與體重變化的關係圖………………………………………………………………58
圖4-13乳癌病患手術後十二個月內有無使用輔助治療與體重變化的關係圖…………………………………………………………60
圖4-14乳癌病患手術後十二個月內有無使用類固醇與體重變化的關係圖……………………………………………………………61
圖4-15乳癌病患手術後十二個月內化學治療種類（CEF vs.CMF）與體重變化的關係圖……………………………………………63
圖4-16控制了年齡與停經狀態後，乳癌病患手術後十二個月內體重變化與化學治療方式（CEF vs.CMF）的關係圖………………67
［附錄目錄］
附錄一 乳房術後症狀研究受試者同意書…………………………86
附錄二 基本資料表…………………………………………………89
附錄三 手術醫療紀錄單……………………………………………96
附錄四 治療紀錄單…………………………………………………99

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