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研究生:謝瑋琳
研究生(外文):Wei-Lin Hsieh
論文名稱:腹主動脈瘤病人經主動脈血管腔內套膜支架置入手術前後生活品質之探討
論文名稱(外文):Comparison on changes in health-related Quality of Life between preoperative and postoperative of endovascular stent insertion for patients with abdominal aneurysm
指導教授:史曉寧史曉寧引用關係
指導教授(外文):Shaw-Nin, Shih
學位類別:碩士
校院名稱:國立陽明大學
系所名稱:臨床暨社區護理研究所
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:179
中文關鍵詞:生活品質腹主動脈瘤支架血管手術
外文關鍵詞:quality of lifeabbominal aortic aneurysmsendovascular
相關次數:
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  • 收藏至我的研究室書目清單書目收藏:1
本研究目的在探討主動脈瘤支架血管手術的患者手術前後生活
品質的變化及其相關因素,為ㄧ描述相關性研究,採追蹤及回溯方式
進行,以WHOQOL-BREF及AUSVIQUOL; Australian vascular quality
of life index等結構式問卷測量此特殊族群手術前準備期、術後出院時、術後返診追蹤之時之生活品質,工具具有良好的信效度,問卷訪談共三十位個案,並以描述性統計、獨立樣本t 檢定、單因子變異數分析、皮爾森積差相關及逐步複迴歸進行統計分析。
本研究結果發現生活品質於術前及手術後出院時(約術後1~2周)
無統計上的顯著差異,而術前與返診時(約術後6周)生活品質有統計上的顯著差異,術後生活品質有隨著時間攀升的趨勢,且比未手術前較佳。
在影響因素方面,術前術後症狀不同(住院期間及返診時肢體活動
不便、術前有無消化道症狀)對手術前後生活品質有顯著差異,而性
別、教育程度、身體容積指數、體重、術前及術後運動頻次對此類病
患之生活品質呈正相關,年齡、子女數、飲酒情形對此類病患之生活
品質呈負相關;術前消化道症狀、術後住院天數、術後住院期間肢體
活動不便、術後住院期間呼吸方面問題及返診時肢體活動不便,對此
類病患之生活品質呈負相關;返診時肢體活動不便之得分與術後住院天數為預測此類病人生活品質重要的兩個預測變項,共可解釋返診時
生活品質60.1%的變異量,期望未來此研究結果能提供給醫護人員用
以改善此類病人之生活品質並能為相關醫療政策提供參考資料。
The purpose of this descriptive study was to explore related factors
and compare the changes in health-related quality of life between preoperative and postoperative of endovascular stent insertion for patients
with abdominal aneurysm. This study was follow-up by longitudinal and retrospective methods. The measurement of instruments included structured questionnaire WHOQOL-BREF and Australian vascular quality of life index (AUSVIQUOL) with good reliability and validity.
The reaseacher used the questionnaire interviewing to the patients which were 30 cases. Data analysis was including descriptive statistics, t-test, one-way ANOVA, Pearson’s correlation and multiple lineal regression.
The results of this study found that the quality of life in these patients before and after surgery at discharge (postoperative stage after 1
~ 2 weeks) was not significant different. The preoperative stage and postoperative stage (after 6 weeks.) the quality of life had statistically
significant differences. There were rising trends over time after the surgery and better than preoperative stage.
Different symptoms before and after operation were significant differences in quality of life. The sex, educational attainment, body mass index, weight,and the frequency of physical activities before and after
the surgery of these patients was positively correlated quality of life. The age, number of children, and drinking of these patients was negative correlated with quality of life. Moreover the preoperative gastrointestinal symptoms, the length of hospital stay after operation, the inconvenience of physical activity during the postoperative hospital stay and symptoms
of respiratory tract were also negatively correlated with quality of life. By using lineal regressing, it was indicated that the inconvenience of physical activity (return to clinic) and the length of hospital stay after operation, were significant predictors and explaned 60.1 % variance in the quality of life (return to clinic).In the future, the results of this study could improve these patients’ quality of life and as a reference for policy makers.
論文電子檔著作權授權書……………………………………………………… i
論文審定同意書………………………………………………………………… ii
誌謝………………………………………………………………………………. iii
中文摘要………………………………………………………………………… iv
英文摘要…………………………………………………………………………. v
目錄……………………………………………………………………………… vi
圖目錄…………………………………………………………………………… vii
表目錄…………………………………………………………………………… viii
第一章 緒論………………………………… ……………………………………………………………1
第一節 研究動機與背景……………………………………………….…………………..….1
第二節 研究目的與研究問題…………………………………………………………..……6
第二章 文獻探討…………………………………………………...……………………….……………8
第一節 主動脈瘤…………………………………………………………………………………………8
一、主動脈生理解剖………………………………………………………….8
二、主動脈瘤發生率……………………………………………………………………………..9
三、主動脈瘤的成因……………………………………………………..……………………..13
四、主動脈瘤的症狀與診斷…………………………………………..…………………….17
第二節 主動脈瘤的治療……………………………………………………………………...20
一、傳統手術………………………………………………..……………………………..20
二、主動脈瘤內套膜支架血管手術…………………….…………………………21
第三節、主動脈瘤支架血管手術照護……………………………………………………25
一、主動脈瘤病患術前健康問題 ………………………..………………………25
二、主動脈瘤支架血管手術術後健康問題與照護……………………25
第四節 生活品質……………………………………………………………………………..…..28
一、健康相關生活品質………………………………………………………………….28
二、健康相關生活品質之影響因素……………………….………………………..31
三、生活品質測量工具………………………………………..………………………..34
四、主動脈瘤內套模支架血管手術與生活品質之相關研究……………38
第三章 研究方法………………………………………………………………………………………..40
第一節 研究設計…………………………………………………………….…………………..40
第二節 研究架構……………………………………………….………………………………..41
第三節 研究對象與場所………………………………………………..…………………….43
第四節 研究工具…………………………………………………………………….…………..44
第五節 資料收集及研究過程………………………………………………………………50
第六節 資料分析………………………………………………………………………………..52
第七節 倫理考量………………………………………………………………………………..58
第四章 研究結果……………………………………………………………..………………………..59
第一節 人口學特性及疾病特性分析…………………………………….……………..59
第二節 腹主動脈瘤病患手術前後生活品質及其之間的關係………….…….69
第三節 支架血管手術前後生活品質與人口學特性之關係………….………..77
第四節 支架血管手術前後生活品質與疾病相關特性之關係………………..81
第五節 影響支架血管手術前後之生活品質的相關因素分析………………...92
第五章 討論……………………………………………………………………………………….…….112
第一節 接受支架血管手術腹主動脈瘤患者人口學特性之探討……………112
第二節 接受支架血管手術腹主動脈瘤患者疾病特性之探討…………….…114
第三節 接受支架血管手術腹主動脈瘤患者手術前後生活品質之探討...116
第四節 接受支架血管手術腹主動脈瘤患者人口學特性與手術前後生活品
質之關係…………………………………………………………………………………………….118
第五節 接受支架血管手術腹主動脈瘤患者疾病特性與手術前後生活品質
之關係………………………………………………………………………………………………..120
第六節 接受支架血管手術腹主動脈瘤患者手術前後生活品質預測因...124
第七節 研究限制………………………………………………………………………………..127
第八節 護理應用………………………………………………………………………………..130
參考資料………………………………………………………………………….………………………..133
中文部份……………………………………………………………………………………….…………..133
英文部份………………………………………………………………………….………………………..139
參與研究者同意書……………………………………………………….…………………………….165
個案基本資料表及問卷……………………………………………………………..……………….166
專家效度名單 …………………………………………………………………………………………177
研究工具使用同意書……………………………………………………………….…………………178
圖目錄
圖3-1 腹主動脈瘤接受支架手術患者手術前後生活品質之差異及其相關因素之
研究架構圖……………………………………….………………………………………………………….42
圖3-2 研究工具發展流程圖…………..…………………………………..………47
表目錄
表2-1 台灣簡明版世界衛生組織生活品質問卷四個範疇題目…….……………36
表3-1 信度分析…………………………………………………………………………….…..…………..49
表 3-2 研究對象之個人基本屬性之描述性統計方法…………………………….………..53
表3-3 研究對象之疾病相關特性、生活品質之描述性統計方法………….………….55
表3-4 自變項與依變項間之統計檢定方式……………………………………….…………….57
表4-1 研究對象基本資料分佈情形………………………………………………….……….……61
表4-2 疾病相關特性分佈情形…………………………………………………………....………….65
表4-3 術後住院期間與返診時不適症狀分布情形 ……………….………..……………...66
表4-4 手術前後運動次術分布情形…………………………………………………….…………..66
表4-5 醫療訊息滿意度及整體滿意度之一覽表………………………………………….……67
表4-6 有無規則服用降血壓藥物之次數分配表……………………………………….………67
表4-7 手術前及返診時測量血壓情形之次數分配表…………………………………………67
表4-8 平均收縮壓於手術前出院時與返診時之次數分配表……………….……………..68
表4-9 平均舒張壓於手術前出院時與返診時之次數分配表………………….…………..68
表4-10 追蹤組與回溯組在生活品質間差異分析…………………………………………..…..69
表4-10-1 WHOQOL-BREF 生活品質各子題平均值及標準差…………………..……….72
表4-11 疾病專ㄧ生活品質各子題平均值及標準差…………………………………..………73
表4-12 三個時間點病患之健康相關生活品質………………………………………………….74
表4-13 手術前後病患填寫WHOQOL-BREF 及各範疇經計算後之平均得分……..74
表4-14 不同時間點生活品質範疇間的差異檢定…..…………..……………………….……76
表4-15 性別與生活品質間差異分析………………………………..………………………….…...78
表4-16 完整婚姻與否與各個範疇生活品質之差異……………..…………………………...78
表4-17 居住狀況與生活品質之變異數分析…………………………….………...…....……….79
表4-18 主要照顧者與生活品質之變異數分析………………………..……………….….79
表4-19 宗教信仰與手術前後生活品質間之變異數分析………………………..…….80
表4-20 術前症狀之有無與生活品質之差異………………………………..……….……..84
表4-21 術前不同症狀與生活品質之差異分析………………………………………..….85
表4-22 住院中症狀與生活品質之差異分析………………………………….….…….…..86
表4-23 出院返診時期症狀與生活品質之差異分析…………………………..……..….87
表4-24 術前消化道症狀與生活品質得分間的差異………………………………....….88
表4-25 罹患高血壓與否與各個範疇之生活品質之差異……………….…………..….88
表4-26 手術前規則服用血壓藥否與生活品質之差異分析………….………………89
表4-27 手術後規則服用血壓藥否與生活品質之差異分析………….………………89
表4-28 術前規則量血壓情形與生活品質的差異………………………….…………….90
表4-29 術後規則量血壓情形與生活品質的差異……………………………………..….90
表4-30 抽菸與否與生活品質之差異分析……………………………………………….…..91
表4-31 醫療訊息滿意度與整體醫療人員滿意度與生活品質之相關分析…......99
表4-32 醫療訊息滿意度與整體醫療人員滿意度與生活品質之相關分析……100
表4-33 人口學特性與生活品質之相關分析……………………………….….……..……101
表4-34 疾病特性與生活品質之相關分析…………….………………….…….….……….102
表4-35 有無測量與控制血壓與生活品質之相關分析…………………………..……103
表4-36 支架血管手術前後血壓與生活品質之相關分析 ……….….…..…….……..104
表4-37 住院期間症狀與生活品質之相關分析………………………………………..….105
表4-38 返診時症狀與生活品質之相關分析……………………………………….………106
表4-39 慢性病與生活品質之相關分析……………………………..………………….…....107
表4-40 自變項對術前WHOQOL-BREF 生活品質之逐步迴歸分析…………....109
表4-41 自變項對出院時WHOQOL-BREF 生活品質之逐步迴歸分析……..…..109
表4-42 自變項對出院返診時WHOQOL-BREF 生活品質之逐步迴歸分析….110
表4-43 自變項對術前疾病專ㄧ生活品質量表得分之逐步迴歸分析………..….110
表4-44 自變項對出院時疾病專ㄧ生活品質量表得分之逐步迴歸分析………..110
表4-45 自變項對出院返診時疾病專ㄧ生活品質量表得分之逐步迴歸分析...111
表4-46 生活品質之迴歸預測方程式………………………………………………………… 111
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