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研究生:詹培梅
研究生(外文):Pei Mei Chan
論文名稱:透析病患與代理人對生活品質評估之比較
論文名稱(外文):The difference between the self-report and proxy-report of the quality of life in dialysis patient
指導教授:劉雪娥劉雪娥引用關係
指導教授(外文):H. E. Liu
學位類別:碩士
校院名稱:長庚大學
系所名稱:護理學研究所
學門:醫藥衛生學門
學類:護理學類
論文種類:學術論文
論文出版年:2009
畢業學年度:97
論文頁數:121
中文關鍵詞:血液透析腹膜透析代理人生活品質
外文關鍵詞:hemodialysisperitoneal dialysisproxyquality of life
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本研究目的在瞭解長期血液透析及腹膜病患合病症嚴重度指數、症狀困擾、憂鬱與生活品質之相關性及長期透析病患代理人對於病患生活品質評估之一致性。採橫斷式調查法,以方便取樣,於北部某醫學中心之血液透析及腹膜透析中心,選取診斷為末期腎臟病,須接受長期血液及腹膜透析治療的病患為研究對象。自民國98年1月至98年5月共收到245份有效問卷。研究工具包括:基本資料表、合併症指數量表、症狀困擾量表、中文版貝氏憂鬱量表、世界衛生組織生活品質問卷-台灣簡明版、家屬基本屬性資料表。所得資料以SPSS17.0版套裝軟體進行建檔,以描述性統計、無母數統計及有母數統計方法等及複廻歸進行分析。研究結果顯示:1、血液透析或腹膜透析病患年齡愈大、合併症指數越高、身體症狀困擾越嚴重、憂鬱情形越嚴重者生活品質越差。2、血液透析與腹膜透析病患在各個次範疇生活品質程度相仿。3、血液透析病患代理人評估病患之生理、社會關係及環境範疇之生活品質得分皆低於病患自評的生活品質得分;腹膜透析家屬能代替病患表達生活品質各範疇情形。根據研究結果,在護理實務、護理教育與護理研究上提出護理應用的建議。期望本研究結果能夠建立本土化的資料,並提供護理人員在瞭解血液透析及腹膜透析病患及作為未來研究之參考。
The purpose of this study was to explore the relationships among comorbidity, symptom distress, depression, and quality of life in long-term dialysis patients. And to understand the difference between the self-report and proxy-report of the quality of life in dialysis patient. This study used a cross-sectional design with purposive sampling. Selected samples diagnosed with ESRD under long-term hemodialysis or peritoneal dialysis were recruited from a major medical center located in northern Taiwan. During January to May, 2008, a total of 245 patients who completed questionnaires were collected. The research instruments in-cluded: Charlson comorbidity index、symptom distress scale、Beck depression inventory scale and WHOQOL-BREF Taiwan version. Data analysis was performed by the Chinese version of SPSS for windows 17.0. The results indicated: 1.Those who reported poor quality of life were characterized with old age, high comorbidity index, associated with symptom distress and depression. 2.The hemodialysis and peritoneal dialysis patient were similar in each category of quality of life. 3.The caregivers of hemodialysis patients significantly underestimated quality of life about the physiology, social relations and environment dimension; the quality of life are consistent between peritoneal dialysis patients and caregivers. Several practical and useful suggestions related to nursing practice, education, and researches were proposed in the text. The results of Taiwanese can help nurses to manage the dialysis patient’s care and to inspire the others conduct future study.
目 錄
指導教授推薦書……………………………………………………… i
口試委員會審定書…………………………………………………… ii
授權書……………………………………………………………… iii
誌謝………………………………………………………………… iv
中文摘要…………………………………………………………… v
英文摘要…………………………………………………………… vi
目錄………………………………………………………………… vii
第一章 緒論……………………………………………………… 1
1.1 研究動機………………………………………………… 1
1.2 研究目的………………………………………………… 3
1.3 名詞界定………………………………………………… 3
第二章 文獻查證…………………………………………………… 6
2.1尿毒症及透析療法……………………………………………… 6
2.2 生活品質……………………………………………………… 8
2.3 影響生活品質的相關因素…………………………………… 13
2.4 代理人評估生活品質………………………………………… 18
第三章 研究方法………………………………………………… 21
3.1研究設計……………………………………………………… 21
3.2研究架構……………………………………………………… 21
3.3研究對象及場所………………………………………………… 22
3.4研究工具………………………………………………………… 23
3.5資料收集過程…………………………………………………… 28
3.6資料處理及分析………………………………………………… 28
3.7研究倫理考量…………………………………………………… 30
第四章 研究結果…………………………………………………… 31
4.1血液透析及腹膜透析病患基本資料…………………………… 32
4.2血液透析及腹膜透析病患身體症狀困擾、憂鬱及生活品質… 41
4.3血液透析及腹膜透析病患人口學、疾病特性與生活品質的
關係…………………………………………………………………… 43
4.4血液透析及腹膜透析病患身體症狀困擾、憂鬱與生活品質
的關係………………………………………………………………… 49
4.5血液透析及腹膜透析病患人口學、疾病特性、症狀困擾與
憂鬱對生活品質的預測因子………………………………………… 51
4.6血液透析及腹膜透析病患與代理人評估之生活品質一致性… 53
第五章 討論………………………………………………………… 57
5.1血液透析及腹膜透析病患人口學、疾病特性及合併症指數
與生活品質的關係…………………………………………………… 57
5.2血液透析及腹膜透析病患之身體症狀困擾、憂鬱與生活品
質的關係.. …………………………………………………………… 61
5.3血液透析及腹膜透析病患生活品質之差異……………………… 62
5.4血液透析及腹膜透析病患之預測因子.. ……………………… 63
5.5血液透析及腹膜透析與代理對於生活品質評估之一致性……… 64
第六章 結論與建議…………………………………………………… 66
6.1結論………………………………………………………………… 66
6.2護理上的應用……………………………………………………… 67
6.3研究限制與建議…………………………………………………… 68
參考文獻……………………………………………………………… 69
附錄…………………………………………………………………… 83
圖表目錄
圖次
研究架構圖………………………………………………………… 21
表次
統計分析表…………………………………………………………… 29
表1.血液透析及腹膜透析收案人數分析……………………………… 32
表2、血液透析及腹膜透析病患人口學特性…………………………… 34
表3、血液透析及腹膜透析病患疾病特性………………………………… 36
表4、血液及腹膜透析病患疾病特性、合併症指數、血液生化值… 40
表5-1、血液透析及腹膜透析病患身體症狀困擾之差異…………… 41
表5-2、血液透析及腹膜透析病患憂鬱量表得分之差異……………… 42
表5-3、血液透析及腹膜透析病患生活品質各範疇得分………………… 42
表6-1、血液透析病患人口學、疾病特性與生活品質之差異……………… 44
表6-2、血液透析病患疾病特性與生活品質之相關………………………… 46
表6-3、腹膜透析病患人口學、疾病特性與生活品質之差異……………… 47
表6-4、腹膜透析病患疾病特性與生活品質之相關………………………… 49
表7-1、血液透析病患身體症狀困擾與生活品質的相關…………………… 49
表7-2、血液透析病患憂鬱與生活品質的差異……………………………… 50
表7-3、腹膜透析病患身體症狀困擾與生活品質的相關…………………… 50
表7-4、腹膜透析病患憂鬱與生活品質的差異……………………………… 51
表8-1、血液透析病患複迴歸分析自變數的共線性診斷…………………… 52
表8-2、血液透析病患整體生活品質的複迴歸分析………………………… 52
表9-1、代理人人口學資料…………………………………………………… 54
表9-2、代理人評估生活品質常態檢定……………………………………… 55
表9-3、血液透析病患與代理人評估生活品質之一致性…………………… 55
表9-4、腹膜透析病患與代理人評估生活品質之一致性…………………… 56
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1. 王麗惠、劉芹芳(2005)‧生活品質概念分析於護理之應用‧高雄護理雜誌,22(2),41-50。
2. 王麗惠、劉芹芳(2005)‧生活品質概念分析於護理之應用‧高雄護理雜誌,22(2),41-50。
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4. 林哲瑩(2006)‧尿毒症透析治療之新進展‧中醫內科醫學雜誌,4(1),19-24。
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15. 陳美玲、顧乃平(1998)‧血液透析病患生活品質及其相關因素之探討‧護理研究,6(5),393-403。