跳到主要內容

臺灣博碩士論文加值系統

(3.95.131.146) 您好!臺灣時間:2021/07/26 03:23
字體大小: 字級放大   字級縮小   預設字形  
回查詢結果 :::

詳目顯示

: 
twitterline
研究生:楊素真
研究生(外文):Su-Chen Yang
論文名稱:末期腎病變患者切除副甲狀腺後症狀困擾及生活品質改善程度之探討
論文名稱(外文):The effect of parathyroidectomy on symptoms distress and quality of life in patients with end-stage renal disease
指導教授:王凱微王凱微引用關係
指導教授(外文):Kai-Wei Wang
學位類別:碩士
校院名稱:國立陽明大學
系所名稱:護理學系暨研究所
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
語文別:中文
論文頁數:76
中文關鍵詞:末期腎病變副甲狀腺增生症狀困擾生活品質
外文關鍵詞:ESRDHyperparathyroidsymptoms distressquality of life
相關次數:
  • 被引用被引用:4
  • 點閱點閱:620
  • 評分評分:
  • 下載下載:139
  • 收藏至我的研究室書目清單書目收藏:4
本研究主要探討末期腎病變患者副甲狀腺增生手術前、後之症狀困擾與生活品質之關係。以追蹤調查研究法,採立意取樣方式,於北部ㄧ家醫學中心進行為期2年收案期;共收集37位副甲狀腺增生手術患者。問卷內容包括基本資料問卷、症狀困擾視覺類比量表、SF-36生活品質問卷量表等工具收集資料,以描述性統計分析、配對樣本t檢定、皮爾森積差相關等統計方法分析資料。
結果顯示:關節疼痛、肌肉無力、皮膚搔癢是末期腎病變合併副甲狀腺增生患者感到最困擾的症狀; 86.5%患者有症狀困擾情形,症狀困擾與生活品質呈負相關,手術後症狀困擾程度改善。
個案的血鈣值與PCS、MCS達顯著負相關;鈣磷乘積與皮膚搔癢成顯著正相關;手術前Albumin值與PCS有顯著相關(r=0.354,p=0.047
),與MCS無顯著相關。手術後三個月PCS、MCS有顯著相關(r=0.374,p=0.035, r=0.416 ,p=0.018)。手術後一個月關節疼痛、肌肉無力及皮膚癢緩解程度呈現顯著差異,持續至手術後3個月仍有統計意義,顯示病人手術後症狀困擾改善,生活品質提升。
手術前SF-36整體得分PCS 31.7± 13.8;得分最低(最低的是RP 31.1±37.9),MCS 37.6±14.4;症狀困擾與整體生活品質呈負相關;
此結果可提供給護理人員了解末期腎病變患者副甲狀腺增生手術前的症狀困擾與生活上之需求情況,提供個別性及適當的照護,進而增進病患的生活品質。
The purpose of this study was to explore the relationship between the symptoms distress and the quality of life in patients with End-Stage Renal Disease before and after parathyroidectomy. A descriptive and correlation study design was undertaken. Thirty-seven participants were recruited from a medical center over two years of period. Data was analyzed by using descriptive statistics, pair t-test and pearson,s correlation.
The result reveals that joint pain, muscle weakness and itchy skin were the most annoying symptoms and the total scores of PCS was 31.7± 13.8,MCS 37.6±14.4 respectively. There were 86.5% of patients indicated experiencing adverse symptoms and as the result affecting their quality of life. However, the symptoms improved after parathyroidectomy. Among these cases, there was a noticeable negative correlation between the level of serum calcium and PCS and MCS; in contrast, a positive correlation between the calcium-phosphorus product and skin itching was observed. Preoperative serum albumin was related to PCS (r=0.354, p=0.047). In addition, after three months of operation there was a significant correlation between the serum albumin level and PCS (r= 0.374, p=0.035) and MCS (r=0.416,p=0.018). Joint pain, muscle weakness, and skin itching have alleviated greatly both at one month and three months of time after parathyroidectomy. The result of this research can facilitate nursing staff to understand the pre-operative symptoms distress and the necessity in patients with ESRD and parathyroidism; and provide them with individually appropriate care to better their quality of life.
中文摘要…………………………………………………………….i
英文摘要………………………………………………………….…ii
誌謝………………………………………………….……………..iii
目錄…………………………………………………………..…….iv
表目錄………………………………………………..……..……..v
第壹章 緒論…………………………………………………….……1
第一節 研究動機與重要性……………………………………1
第二節 研究問題及研究目的…………………………………2
第三節 研究假設………………………………………………2
第四節 名詞界定………………………………………………3
第五節 研究意義………………………………………………4
第貳章 文獻查證......................................................5
第一節 腎臟正常功能與腎衰竭......................................................5
第二節 副甲狀腺的構造與功能......................................................7
第三節 副甲狀腺素與活性維生素D…………………….……8
第四節 副甲狀腺功能亢進與腎性骨病變………………..…10
第五節 次發性副甲狀腺治療及術後合併症.........….…14
第六節 腎衰竭病人的生活品質…………….....…….……18
第七節 文獻摘要……………………….……………….……30
第參章 研究方法......................................................36
第一節 研究架構……………………...….…….……...…37
第二節 研究設計……………………….…………….………37
第三節 研究對象與研究場所……………………………..…37
第四節 研究工具與測量……………………………..………37
第五節 資料收集過程 ……………………………………40 第六節 研究對象的權益與保護………………………………42
第七節 資料分析與統計……………………………………..42
第肆章 研究結果……………………………….……………………45
第一節 問卷調查回收情行............................44
第二節末期腎病變患者副甲狀腺增生手術前的基本屬性及症狀困擾.....45
第三節副甲狀腺增生手術前、後,基本屬性與生活品質之關係......................................................56
第伍章 討論………………....………………………….......…58
第一節 副甲狀腺增生手術個案基本屬..................61
第二節 手術前、後生活品............................61
第三節 末期腎病變患者副甲狀腺增生手術前、後臨床檢..62
第四節 手術前、後症狀困擾改善程度………………………65
第五節手術前、後生活品質改善程.....................66
第陸章 結論與建議.......................................68
第一節結論…………………….......………………………68
第二節護理照護之應用…………………………...........68
第三節研究限制與建議………………..…………….....…70
參考文獻................................................71
中文部份…………………………...........………………71
英文部份...........................................72
毛莉雯、邱亨嘉、張碧玉、黃素貞、黃尚志(2008).透析模式對台灣末期腎臟疾病患者健康相關生活品質之影響.高雄醫誌,24(9),453–460。
呂嘉陞、林建宇、邱顯邦 (2008) .透析治療臨床實證指引.台北:合記圖書出版社。
陳永銘、黃秋錦(2007,6月29日).全民健保品質理監委員會報告.台灣腎臟醫學.2009年05月03日取自http://www.areahp.org.tw/upload/project/txt/960705B.ppt
黃志強(2004).血液透析學.台北:合記圖書出版社。
黃尚志(2007,10月6日).台灣慢性腎臟病防治現況與展望台灣腎臟醫學會CKD防治委員會.2009年05月03日取自http://www.capd.com.tw/2_4_2/1216PDforum/t.pdf.
黃淑貞、林其璘、李秀英、楊素真、何泰儀、洪冠予(2005).尿毒性搔癢症:相關因子及現行治療方式成效之探討.台灣腎臟護理學會雜誌,4(1),17-24。
鈕淑芬(2004).透析病患之生活品質及其相關因素探討.台灣腎臟護理學會雜誌,(3)2,88-96。
劉絮穎(2003).尿毒病患副甲狀腺功能亢進的外科治療.高雄榮總醫訊,6(11),17-20。
楊志偉、蘇娳敏、陳泰瑞(2005).生活品質量表在臨床及研究上的應用.高雄縣醫師會誌,18,46-53。
鄭世平、楊圳隆、李居仁、吳志仁、陳逸洲、葉瑞圻、陳漢湘(2009).腎性副甲狀腺機能亢進的機轉與治療.內科學誌,20(1),30-35。
譚柱光、楊五常(2005).人工腎臟.台北:力大圖書.
龔松保(2005).副甲狀腺高能症外科治療概要.臨床醫學,55(4),279-287。
Ageborg,M.,Allenius,B.L.,& Cederfjall,C.(2005). Quality of life,self-care ability and sense of coherence in hemodialysis patients:a comparative study.International Society for Hemodialysis,9(4),8-14.
Amin,N,(2002).The impact of improved phosphorus control:use of sevelamer hydrochloride in patient with chronic renal failure. Nephrology Dialysis Transplantation,17(2),340-345.
Armstrong, T. S. (2003). Symptoms experience: a concept analysis. OncologyNursing Forum, 30(4), 601-606.
Block ,G.A.,Hulbert-Shearon,T.E.,Levin,N.W.,& Pork,F.K.(1998). Association of serum phosphorus and calcium x phosphate product with mortality risk in chronic hemodialysis patients: a national study.Journal of the American kidney Dis, 31(4),607-617.
Chiang ,C.K.,Peng,Y.S., Chiang,S.S.,Yang,C.S.,He,Y. H.,Hung, K.Y., Wu,K.D.,
Wu,M.S.,Fang,C.C.,Tsai,T.J.,& Chen,W.Y.,(2004). Health-Related Quality of Life of Hemodialysis Patients in Taiwan:A Multicenter Study. Blood Purif,
22,(),490–498
Davison,S.N., Jhangri,G.S.,& Johnson,J.A.(2006). Longitudinal Validation
of a modified Edmonton symptom assessment system(ESAS) in haemodialysis patients. Nephrology Dialysis Transplantation,21,3189-3195.
Drueke,T.B.,& Eckardt,K.U.(2002).Role of secondary hyperparathyroidism in erythropoietin resistance of chronic renal failure patients.Nephrology Dialysis Transplantation,17(5),28-31.
Ganesh,S.K.,Stack ,A.G.,Levin ,N.W.,Hulbert-Shearon ,T.,&port,F.K.(2001). Association of elevated serum PO(4), Ca x PO(4) product,and parathyroid hormone with cardiac mortality risk in chronic hemodialysis patient. Journal of American Society Nephrology,12(10),2131-2138.
Jablonski,A (2007).Level of symptom relief and need forpalliative care in the hemodialysis population.Journal of Hospice and Palliative Nursing,9(1),50-58.
KDOQI clinical practice guidelines for bone metabolism and disease in children
with chronic kidney disease. ( 2005)National Kidney Foundation Inc. 2009年
05月05日取自
http://www.kidney.org/professionals/kdoqi/guidelines_pedbone/guide15.htm

Legg,V.(2005).Complication of chronic kidney disease :a close look at renal osteodystrophy nutritional disturbance and inflammation. American Journal of nursing,105(6),40-49.
Locatelli,F.(2004).The need for better control of secondary hyperparathyroidism.Nephrology Dialysis Transplantation,19(5),15-19.
Locatelli,F.,Cannata-Andia,J.B.,Drueke,T.B.,Horl,W.H.,Fouque,D.,He imburger,O.,& Ritz,E.(2002).Management of disturbance of calcium and phosphate metabolism in chronic renal insuiciency with emphasis on the controlos hyperphosphataemia.Nephrology Dialysis Transplantation,17(5),723-731.
Loos,c.,Briançon,S.,Frimat,L.,Hanesse,B.,Hanesse,B.,& Kessler,M. (2003). Effect of end-stage renal disease on the quality of life of older patients. Journal of the American Geriatrics Society,51(2),229-233.
Thong ,M.Y. Dijk,S.,Noordzij,M., Boeschoten, E.W., Krediet,R.T., Dekker F.W. ,&Kaptein,A.A.(2009). Symptom clusters in incident dialysis patients:associations with clinical variables and quality of life. Nephrology Dialysis Transplantation,24,225-230.
Maureen,M.,& Donna.G, (2004).Secondary hyperparathyroidism in chronic kidney disease:clinical consequences and challenges.Nephrology Nursing Journal,31(2),185-193.
Mingardi,G.(1998).From the development to the clinical application of a questionnaire on the quality of life in dialysis.The experience of the Italian collaborative DIA-QOL(Dialysis-quality of life)group. Nephrology Dialysis Transplantation,13(1),70-75.
Mittal,S.K.,Ahern,L.F.,Edith,M.K.,& Steven,F.(2001).Self-assessed physical and mental function of haemodialysis patients. Nephrology Dialysis Transplantation,16(7),1387-1394.
Moe,S.M.,& Drueke,T.B.(2003).Management secondary hyperparathyro idism:the importance and the challenge of controlling parat hyroid hormone level without elevating calcium,phosphorus,and calcium phosphorusproduct.American Journal of Nephrology,23(6),369-379.
Pasieka,J.L.(2003). Surgical approach secondary hyperparathyroidism .Poblems in General Surgery,20(3),61-67.
Pemeger,T.V, Leski,M.,Chopard-Stoermann,C.,Martin,P.Y.(2003).Assessment
of health status in chronic hemodialysis patients.

Pisoni, R.L., Wikstrom, B., Elder, S. J., Akizawa,T. Asano,Y.,Keen,M.L., Saran, R.,Mendelssohn,D.C.,Young,E.W.,&Pork,F.K.(2006). Pruritus in haemodialysis patients:International results from the Dialysis Outcomes Patterns Study(DOPPS). Nephrology Dialysis Transplantation,21(12),3495-3505.
Stojanovic,M.& Stefanovic,V.(2007).Assessment of health-related quality of life in patients treated with hemodialysis in Serbia:influence of comorbidity,age and income.International Center for Artificial Organs and Transplantation,31(1),53-60.
Tanaka,M.,Yamazaki,S.,Hayashino,Y.,Fukuhara,S.,Akiba,T.,Saito,A., Asano,Y.,Port,K.,Kurokawa,K.& Akizawa,T.(2007).Hypercalcaemia is associated with poor mental health in haemodialysis patient:result from Japan DOPPS. Nephrology Dialysis Transplantation,22(6),1658-1664.
Tominaga,Y.(1999).Surgical management of secondary hyperparathyroidism in uremia.The American Journal Medical Society,317(6),390-403.
USRDS.(2008)Annual Data Report: Atlas of Chronic Kidney Disease and
End-Stage Renal Disease in the United States" NIH2008.Retrieved May
3,2009, 2009年05月05日取自http://www.medpagetoday.com/Nephrology/
GeneralNephrology /11269 - 54k
USRDS.(2008)Annual Data Report:incidence & prevalence. 2009年05月05日
取自http://www.usrds.org/2008/pdf/V2_02_2008.pdf
Vasilieva,I.A.(2006).Quality of life in chronic hemodialysis patient in Russia. International Society for Hemodialysis,10(3),274-279.
Ware,J.E., Kosinski M, Keller SD: SF-36 Physical and Mental Health Summary Scales: A User’s Manual. Boston, New England MedicalCenter, The Health Institute, 1994.
QRCODE
 
 
 
 
 
                                                                                                                                                                                                                                                                                                                                                                                                               
第一頁 上一頁 下一頁 最後一頁 top