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研究生:李家瑩
研究生(外文):Chia Ying Li
論文名稱:接受化學治療之乳癌婦女其經期改變及更年期症狀之探討
論文名稱(外文):Menstruational change and climacteric symptoms in women with breast cancer receiving chemotherapy
指導教授:陳美伶陳美伶引用關係
指導教授(外文):M. L. Chen
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:2010
畢業學年度:98
論文頁數:112
中文關鍵詞:乳癌婦女化學治療經期改變
外文關鍵詞:breast cancerchemotherapymenstrual change
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本研究主要研究目的在探討:(1)化學治療前未停經之乳癌病人,於化學治療後引起經期改變發生的情形,(2)經期改變狀態對化學治療前後更年期症狀嚴重度及困擾程度的影響。共84位病人進入分析。結果發現(1)化學治療引起經期改變發生的情形佔75%,其中以月經停止且至第二年仍未恢復者佔多數(79.4%)。(2)年齡大者化療後引起經期改變的機會較年齡輕者高。(3)整體症狀表現上,心理症狀嚴重度為一向下的趨勢;心理症狀困擾度及身體症狀方面,得到一個U字型的症狀表現;血管舒縮及性慾降低症狀方面,得到一倒U的症狀表現;但在統計檢定後發現,心理症狀嚴重度及性慾降低症狀嚴重度/困擾度的時間變化並不具統計顯著意義。(4)除性慾降低嚴重度外,其餘症狀表現皆不受有無經期改變的影響;有月經中斷者其性慾降低症狀嚴重度的變化幅度較持續有月經者明顯。本研究可提供臨床醫護人員對乳癌病人因化療所引起之經期改變及更年期症狀的變化趨勢有初步了解。
This study aimed to examine: (1) the chemotherapy induced change of menstruation in pre-menopausal women with breast cancer; and (2) the effect of menstrual change in the severity and distress of climacteric symptoms. Data from 84 patients were analyzed. The results showed that: (1) Seventy-five percent had experienced menstrual change and most of them (79.4%) did not recover after two years. (2) Older women tended to have higher chance to experience menstrual change. (3) In terms of change pattern, the severity of psychological symptoms is gradually decreased; the trend of psychological distress and physiological symptoms demonstrated U shape while the vasomotor and sexual symptoms are reversed U shape. Except psychological (severity) and sexual (severity and distress) symptoms, the trends of all other symptoms showed significant time effects. (4) Menstrual change had significant effect on change of the severity of sexual symptoms; the magnitude of increase and decrease in sexual symptom severity was larger in women experiencing menstrual disruption. This investigation can provide understanding on menstrual change and climacteric symptoms in breast cancer women undergoing chemotherapy.
目 錄 指導教授推薦書………………………………………………………… 口試委員會審定書……………………………………………………… 授權書…………………………………………………………………iii 誌謝……………………………………………………………………iv 中文摘要………………………………………………………………v 英文摘要………………………………………………………………vi 目錄……………………………………………………………………viii 論文目次……………………………………………………………ix 表目錄………………………………………………………………xi 圖目錄………………………………………………………………xiii 附錄目次……………………………………………………………xiv [論文目次] 第一章 緒論………………………………………………………1 1.1 研究動機與重要性…………………………………………1 1.2 研究目的……………………………………………………5 1.3 研究問題……………………………………………………5 1.4 名詞解釋……………………………………………………6 第二章 文獻查證……………………………………………………7 2.1 化學治療與停經……………………………………………7 2.2 乳癌病人與停經症狀………………………………………17 第三章 研究方法…………………………………………………22 3.1 概念架構……………………………………………………22 3.2 研究設計……………………………………………………23 3.3 研究場所及對象……………………………………………24 3.4 研究工具……………………………………………………25 3.5 資料收集過程………………………………………………28 3.6 資料分析……………………………………………………31 3.7 研究倫理考量………………………………………………33 第四章 研究結果……………………………………………………………34 4.1 乳癌病人人口學、疾病及治療特性…………………………34 4.2 化學治療後引起經期改變情形………………………………36 4.3 人口學及疾病特性與化學治療後經期改變的關係…………37 4.4 在化學治療前後整體更年期症狀嚴重度及困擾程度的長期變化…38 4.5 化學治療前後不同經期改變狀態之乳癌婦女,更年期症狀嚴重度及 困擾程度的長期變化………………………………55 第五章 討論…………………………………………………………66 5.1 化學治療前未停經之乳癌病人,於化學治療後引起經期改變發生的情形…………………………………………………66 5.2 乳癌婦女在化學治療前後,更年期症狀嚴重度及困擾程度的長期變化表現……………………………………………….68 5.3 經期改變狀態對乳癌婦女,在化學治療前後更年期症狀嚴重度及困擾程度的長期變化情形是否不同………………71 第六章 結論與建議…………………………………………………74 6.1 結論…………………………………………………………74 6.2 護理上的應用………………………………………………75 6.3 研究限制與建議……………………………………………77 參考文獻……………………………………………………………… 79 附錄…………………………………………………………………… 93 [表 目 錄] 表2-1 化學治療引起停經發生率及其干擾變項……………………13 表2-2 乳癌病人與更年期症狀表現及其干擾變項…………………19 表3-1 症狀變項對照表………………………………………………27 表3-2資料收集時間表………………………………………………30 表4-1 基本人口學特性與疾病特性…………………………………35 表4-2 經期改變狀態…………………………………………………36 表4-3 經期改變狀態之人口學………………………………………37 表4-4 經期改變狀態之疾病及治療特性……………………………38 表4-5 各症狀的時間模式適配度……………………………………41 表4-6 心理症狀嚴重度及困擾度的模式參數估計…………………43 表4-7 身體症狀嚴重度及困擾程度的模式參數估計………………46 表4-8 血管舒縮症狀嚴重度及困擾程度的模式參數估計…………49 表4-9 性慾降低症狀嚴重度及困擾程度的模式參數估計…………52 表4-10 整體症狀總表…………………………………………………54 表4-11 加入經期改變狀態變項後心理症狀嚴重度及困擾度的模式參數估計…………………………………………………………57 表4-12 加入經期改變狀態變項後身體症狀嚴重度及困擾度的模式參數估計…………………………………………………………59 表4-13 加入經期改變狀態變項後血管舒縮症狀嚴重度及困擾度的模式參數估計……………………………………………………61 表4-14 加入經期改變狀態變項後性慾降低症狀嚴重度及困擾度的模式參數估計……………………………………………………63 表4-15 兩組症狀差異總表……………………………………………65 [圖 目 錄] 圖3-1 概念架構圖……………………………………………………22 圖3-2 收案流程圖…………………………………………………29 圖4-1 心理症狀嚴重度的表現………………………………………44 圖4-2 心理症狀困擾度的表現………………………………………44 圖4-3 身體症狀嚴重度的表現………………………………………47 圖4-4 身體症狀困擾度的表現………………………………………47 圖4-5 血管舒縮症狀嚴重度的表現…………………………………50 圖4-6 血管舒縮症狀困擾度的表現…………………………………50 圖4-7 性慾降低症狀嚴重度的表現…………………………………53 圖4-8 性慾降低症狀困擾度的表現…………………………………53 圖4-9 加入經期改變此變項後性慾降低症狀嚴重度表現…………64 [附錄目次] 附件一 基本資料量表………………………………………………93 附件二 治療記錄單…………………………………………………94 附件三 自擬經期狀況調查表………………………………………96 附件四 更年期症狀量表……………………………………………97
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