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研究生:陳薇君
研究生(外文):Wei-Chun Chen
論文名稱:透析患者周邊神經病變與睡眠品質相關性探討
論文名稱(外文):Peripheral Neuropathy and Quality of Sleep in Patients Receiving Dialysis
指導教授:賴裕和賴裕和引用關係
指導教授(外文):Yeur-Hur Lai
學位類別:碩士
校院名稱:國立臺灣大學
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:2008
畢業學年度:97
語文別:中文
論文頁數:67
中文關鍵詞:末期腎病變透析治療周邊神經病變神經病變性疼痛睡眠品質
外文關鍵詞:ESRDdialysisperipheral neuropathyneuropathic painquality of sleep
相關次數:
  • 被引用被引用:1
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  • 收藏至我的研究室書目清單書目收藏:1
在透析患者的神經病變中,周邊神經病變是常見的其中之一,而其主要是以感覺、運動神經受損的混合症狀表現。本研究目的主要探討透析患者的周邊神經病變的特質及嚴重度及周邊神經病變性疼痛與患者睡眠品質之關係。研究設計採橫斷性、描述相關性研究法,以立意取樣於北部某醫學中心透析患者為研究對象,研究工具採用「密西根神經病變量表」來評估患者周邊神經病變症狀及足部檢測,「神經病變性疼痛量表」測量患者神經性疼痛情形、「醫療成果指標睡眠品質量表」來測量患者睡眠品質、「症狀嚴重度量表」,評估透析患者常見症狀困擾、「醫院焦慮及憂鬱量表」之憂鬱次量表評估患者憂鬱情形、以及「基本資料表」收集個案相關臨床資料,於97年4月至97年10月共收腹膜透析及血液透析患者162位。研究結果顯示有48位 (29.6%) 患者有周邊神經病變,其中以麻麻症狀發生率最高有64.6%,其次是刺痛感覺 (37.5%),有41.7%覺得症狀在夜晚更嚴重。48位中有19位患者 (39.5%) 有神經病變性疼痛情形,以疼痛造成不愉快、尖銳刺痛為最常見的疼痛特質。血液透析患者周邊神經病變嚴重度得分顯著高於腹膜透析患者 (p=.03),特別是透析量 (Kt/V)小於1.2者周邊神經病變較嚴重 (p=.003),而年齡 (p<.001)、鉀離子 (p=.003)與周邊神經病變有顯著相關,特別是年齡大於65歲者 (p<.001)、鉀離子濃度超過4.3 mmole/L (p=.001)者周邊神經病變較嚴重。而患者的周邊神經病變 (p<.01) 及神經病變性疼痛 (p<.05) 與睡眠品質均有顯著正相關,且研究結果顯示有周邊神經病變合併神經病變性疼痛的患者 (11.7%),睡眠品質是最差的。本研究有助於臨床護理人員對於透析患者周邊神經病變症狀有更深入的瞭解,並提供將來臨床照護及研究上的一個參考依據。
Among dialysis patients, one of the most common neuropathy is peripheral neuropathy, charactered by symptoms of sensori-motor polyneuropathy. The purposes of this crossectional, correlational study were to identify (1) the symptoms and severity of peripheral neuropathy in dialysis patients, and (2) the correlation between peripheral neuropathy with or without peripheral neuropathic pain versus quality of sleep. Eligible patients (who receive dialysis therapy more than 3 months) were recruited from a medical center in Taipei. Data were collected by Michigan Neuropathy Screening Instrument (MNSI), Neuropathic Pain Scale (NPS), Medical Outcome Study Sleep Scale (MOS-Sleep Scale), Symptom Severity Scale (SSS), and Hospital Depression Subscale (HDS). A total of 162 dialysis patients were studied. The results indicated that 48 patients (30%) with a clinical MNSI score≧2 had peripheral neuropathy. The most common symptom was numbness (64.6%), followed by worse at night (41.7%) and prickling (37.5%). Of 48 patients, 19 had peripheral neuropathic pain, charactered by unpleasant feeling and sharp pain (73.7%). The scores of peripheral neuropathy were more severe in hemodialysis patients than in peritoneal dialysis patients (p=.03), especially under adequacy dialysis (Kt/V<1.2) with hemodialysis. Peripheral neuropathy was associated with age (p<.001), and potassium (p=.003), especially age over 65 or potassium over 4.3 mmole/L. There were also significant relationship between peripheral neuropathy and quality of sleep (p<.01); and between neuropathic pain and quality of sleep (p<.05). Patients (11.7%) with peripheral neuropathy and neuropathic pain experienced the worst quality of sleep. In conclusion, our data provides more information about peripheral neuropathy perceived by dialysis patients for further clinical care and related studies.
致謝 II
中文摘要 III
英文摘要 IV
目錄 V
表目錄 VI
圖目錄 VI
第一章 緒論 1
第一節 研究動機與背景 1
第二節 研究目的 4
第二章 文獻查證 5
第一節 末期腎病變 5
第二節 透析患者周邊神經病變 7
第三節 睡眠品質 11
第三章 研究方法 14
第一節 研究設計 14
第二節 研究假設 15
第三節 研究場所及對象 16
第四節 概念架構 17
第五節 研究工具 18
第六節 資料收集及資料分析 23
第七節 倫理考量 25
第四章 研究結果 26
第一節 透析患者之基本資料分析 26
第二節 透析患者周邊神經病變及神經病變性疼痛特質及嚴重度 29
第三節 透析患者身體症狀、憂鬱及睡眠品質程度 35
第四節 透析患者周邊神經病變與病人特質、疾病狀態、主要臨床檢
驗值之情形 39
第五節 透析患者周邊神經病變及神經病變性疼痛與睡眠品質相關性 43
第五章 討論 48
第一節 透析患者周邊神經病變及神經病變性疼痛之特質及嚴重度 48
第二節 透析患者症狀嚴重度、憂鬱與睡眠品質程度 50
第三節 透析患者周邊神經病變與病人特質及疾病治療狀態之關係 52
第四節 透析患者周邊神經病變、神經病變性疼痛與睡眠品質之關係 54
第六章 結論與建議 56
第一節 結論 56
第二節 研究限制 57
第三節 建議 58
參考資料 60

表目錄
表一 透析患者基本屬性 27
表二 透析患者血液檢驗值 28
表三 患者的周邊神經病變問卷評估得分情形 30
表四 患者的周邊神經病變足部檢測評估得分情形 31
表五 患者周邊神經病變性疼痛得分情形 34
表六 透析患者身體症狀得分情形 37
表七 患者睡眠品質得分情形 38
表八 人口學特性、疾病特性、主要檢驗值在周邊神經病變得分差異 40
表九 年齡、透析量、鉀離子與周邊神經病變之相關性 41
表十 患者周邊神經病變與睡眠品質相關性 45
表十一 患者神經病變性疼痛與睡眠品質相關性 46
表十二 周邊神經病變與神經病變性疼痛分組得分差異情形 47
圖目錄
圖一 研究架構 17
圖二 足部檢測得分分布情形 32
圖三 不同透析方式的透析量與周邊神經病變得分差異情形 42
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