臺灣博碩士論文加值系統

全身性紅斑狼瘡患者常因害怕長期使用類固醇，造成身體外表的改變，以致服藥的遵從度降低，影響疾病治療，導致疾病加速惡化及生活品質下降。研究目的在探討服用類固醇之全身性紅斑狼瘡患者，於身體心像、服藥遵從行為與生活品質之間的相關性。研究設計為橫斷式相關性研究，以立意取樣、使用結構式問卷於中部某醫學中心免疫風濕科門診收案，測量內容包括身體心像、身體質量指數、服藥遵從行為及生活品質，總收案數為226人。以SPSS 15.0電腦套裝軟體進行統計分析，以獨立樣本t 檢定、皮爾森積差相關及迴歸進行資料分析。結果為（ㄧ）患者平均年齡34.8歲，罹病時間為10.4年，身體質量指數為22.99，每日類固醇服用量為9.46毫克，有53.1%診斷腎臟病變（二）身體質量指數26.9%大於25，對體重不滿意；高中（職）以上的教育程度及全職工作者對身體心像中外表的在意程度較高（三）患者服用類固醇的藥物遵從行為，發現有62.8%不完全接受治療，有46.9%服用中藥或偏方，43.4%沒按時服藥，41.6%會減少服藥量（四）患者身體心像中的外表評估、身體滿意度與生活品質各層面有顯著正相關（五）腎臟切片腎絲球腎炎分級輕症者服藥遵從行為比重症者差（OR=0.3, p< .05）；就按藥物量服用而言，已婚者服藥遵從行為比未婚者差（OR=0.3, p< .05）；有全職工作者比無就業者的服藥遵從行為差（OR=0.3, p< .05）。結論是身體心像與生活品質有良好的相關性，但與服藥遵從行為無關。因此應就全職、已婚及腎臟切片腎絲球腎炎分級輕症者加強疾病及藥物的衛教指導。

The patients with Systemic Lupus Erythematosus (SLE) under long term
Corticosteroid treatment usually had poor medication adherence. The purpose of this study was to investigate the relationship among body image, medication adherence and quality of life in the patients with SLE under long term Corticosteroid treatment. This study is a descriptive cross-sectional research design. Through purposive sampling, the 226 samples were recruited from the Rheumatology Clinic of a medical center which is located in central Taiwan. The Body Image, medication adherence scale and WHOQOL-BREF(TW) were assessed. One-sample t test, Pearson correlation and logistic regression were applied to analysis the data. The results showed: (1) The subjects mean age , disease duration and body mass index were 34.8 , 10.4 years and 22.99 , respectively. 53.1% of subjects were diagnosis Lupus nephritis , the mean dosage of Corticosteroid treatment was 9.46mg. (2)62.8% did not completely adhere medication，46.9% combined Chinese medication，43.4% adhered behavior without timing，41.6% reduced dosage.(3) The body image of appearance evaluation and body areas satisfaction correlated significantly with quality of life. (4)The medication adherence for patients with mild glomerulonephritis（class 0- II）was poor compared with patients with sever glomerulonephritis（class III - VI）（OR=0.3, p< .05）. This study provide information to clinician to give more education of medication and disease for SLE patients.

誌謝..............................................................................................................................i
中文摘要.....................................................................................................................ii
英文摘要....................................................................................................................iii
目錄............................................................................................................................iv
表目錄.......................................................................................................................vii
圖目錄.......................................................................................................................vii
第一章 緒論...................................................................................................................1
第一節 研究背景與動機...................................................................................1
第二節 研究目的...............................................................................................3
第三節 名詞界定...............................................................................................3
第四節 研究的重要性.......................................................................................4
第二章 文獻查証...........................................................................................................6
第一節 全身性紅斑狼瘡的症狀.......................................................................6
第二節 全身性紅斑狼瘡的類固醇藥物治療...................................................7
第三節 全身性紅斑狼瘡患者服藥的遵從行為...............................................8
第四節 全身性紅斑狼瘡身心社會功能的影響...............................................9
第五節 身體心像.............................................................................................10
第六節 身體質量指數.....................................................................................12
頁次
第三章 研究方法.........................................................................................................14
第一節 研究設計與研究架構.........................................................................14
第二節 研究對象.............................................................................................15
第三節 研究工具.............................................................................................16
第四節 資料蒐集過程.....................................................................................22
第五節 倫理考量.............................................................................................23
第六節 資料處理與統計分析.........................................................................24
第四章 研究結果.........................................................................................................26
第一節 全身性紅斑狼瘡患者之基本資料分佈............................................26
第二節 全身性紅斑狼瘡患者身體心像現況分析.........................................29
第三節 個人背景因素與身體心像之關係分析.............................................33
第四節 全身性紅斑狼瘡患者身體外觀現況分析.........................................36
第五節 全身性紅斑狼瘡患者服藥遵從行為現況.........................................40
第六節 全身性紅斑狼瘡患者生活品質現況.................................................45
第七節 全身性紅斑狼瘡患者對服藥遵從行為的預測分析.........................50
第五章 討論.............................................................................................................57
第一節 研究樣本之人口學特質.....................................................................57
第二節 全身性紅斑狼瘡患者身體心像的現況與疾病診斷的差異異.........58

頁次
第三節 全身性紅斑狼瘡患者身體心像與身體外觀的比較.........................60
第四節 全身性紅斑狼瘡患者之生活品質與身體心像、服藥遵從行為
的相關性.............................................................................................61
第五節 全身性紅斑狼瘡患者服藥遵從行為的預測.....................................62
第六章 結論與建議............................................................................................63
第一節 結論.....................................................................................................63
第二節 護理的應用........................................................................................64
第三節 研究限制與建議................................................................................65
參考資料.................................................................................................................67
中文部分...........................................................................................................67
英文部分...........................................................................................................69
附 錄......................................................................................................................viii
附錄ㄧ、問卷內容之專家名單.............................................................................viii
附錄二、台灣版世界衛生組織生活品質問卷使用同意書…..............................ix
附錄三、中文版身體心像量表問卷使用同意書...................................................x
附錄四、正式問卷...................................................................................................xi
附錄五、人體試驗委員會同意書.........................................................................xvii

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