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研究生:黃勇傑
研究生(外文):Yung-Chieh Huang
論文名稱:氫離子幫浦抑制劑輔以衛生教育介入對胃食道逆流性疾病及其症狀影響尺度改善之探討
論文名稱(外文):Effect of Proton Pump Inhibitors (PPIs) with Health Education Intervention on Gastroesophageal Reflux Disease (GERD) and the Disease Impact Scale
指導教授:高森永高森永引用關係朱恆成朱恆成引用關係
指導教授(外文):Senyeong KaoHeng-Cheng Chu
口試委員:董和銳高森永朱恆成
口試委員(外文):Ho-Jui TungSenyeong KaoHeng-Cheng Chu
口試日期:100年5月24日
學位類別:碩士
校院名稱:國防醫學院
系所名稱:公共衛生學研究所
學門:醫藥衛生學門
學類:公共衛生學類
論文種類:學術論文
論文出版年:2011
畢業學年度:99
語文別:中文
論文頁數:136
中文關鍵詞:胃食道逆流性疾病氫離子幫浦抑制劑衛生教育介入胃食道逆流性疾病影響尺度(GIS)改良型胃食道逆流性疾病影響尺度(mGIS)
外文關鍵詞:Gastroesophageal Reflux DiseaseProton Pump Inhibitorshealth education interventionGastroesophageal Impact Scale (GIS)modified Gastroesophageal Impact Scale (mGIS)
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研究背景:近年隨著國人飲食西化、生活型態改變及肥胖人口的增加,胃食道逆流性疾病(Gastroesophageal Reflux Disease, GERD)之發生率及盛行率呈現逐年增加之趨勢。然而現行臨床醫事人員針對GERD病人之診斷及治療僅著重於內科藥物之投予,藉以抑制胃酸分泌及中和胃酸,或採用外科手術治療,鮮少針對病人之飲食習慣、生活型態調整、疾病相關認知、態度與行為進行衛生教育介入之輔助性治療,或針對衛生教育介入之成效進行評估。

研究目的:本研究目的為探討臨床上投予氫離子幫浦抑制劑輔以衛生教育介入,探討其對GERD病人之飲食及生活習慣、疾病相關認知、態度與行為、GERD臨床症狀影響尺度及內視鏡嚴重度改善之成效,進而探討GERD病人疾病臨床症狀影響尺度改變量(∆mGIS)之預測因子。

研究方法:本研究為隨機控制試驗(Randomized Controlled Trial, RCT)並追蹤6-8周,將181位GERD病人隨機分派至實驗組(N=92)或控制組(N=89)。採自擬結構式問卷及上消化道內視鏡檢查報告進行資料收集。調查內容包含基本人口學特性、飲食、生活習慣或行為、GERD相關認知、態度與行為及改良型GERD影響尺度(modified Gastroesophageal Impact Scale, mGIS)。實驗組接受氫離子幫浦抑制劑(Proton Pump Inhibitor, PPIs)治療及衛生教育介入措施;控制組則接受PPIs治療及門診常規照護。本研究採用SPSS 18.0版進行統計分析,顯著水準為p-value <0.05,利用卡方檢定、獨立樣本t檢定、相關矩陣、配對t檢定及多元線性迴歸等統計分析方法探討衛生教育介入成效。

研究結果:研究結果顯示實驗組相較控制組於前測至6-8周追蹤期間,有效改變飲食習慣、生活習慣或行為、提升對GERD之認知、態度與行為及減少mGIS分數。其中,避免或減少喝茶、喝咖啡、飯後喝湯、吃辛辣類食物、維持規律運動、對GERD之認知、態度與行為及mGIS分數之改變情形,實驗組皆優於控制組。此外,實驗組在避免不良飲食習慣、生活習慣或行為及提升對GERD之認知與行為者,其前、後mGIS分數之改變量均顯著地優於控制組。經多元逐步迴歸分析後顯示:實驗組提升GERD認知(β=1.221,t=2.716)、避免吃甜食(β=0.101,t=3.644)及睡覺枕頭刻意墊高(β=0.539,t=12.344)為衛生教育前、後mGIS分數改變量之預測因子。

結論:GERD病人服用PPIs輔以衛生教育介入可有效改善GERD病人部分不良飲食習慣及生活習慣或行為,並增進對疾病相關認知、態度與行為及減少受疾病影響之程度。惟其對於內視鏡嚴重度(L.A. Grade) 之影響仍有待更長時間之觀察與更進一步之研究釐清。

Background: Gastroesophageal Reflux Disease (GERD) has become a public issue in Taiwan. The incidence and prevalence rate of GERD growing up with aging, westernized diet, lifestyle changes and obesity. However, current clinical diagnosis and treatment only focus on surgery or drugs to inhibit gastric acid secretion, seldom takes into consideration the effect of health education adjuvant treatment, which includes diet, lifestyle modification and disease knowledge, attitude and practice (KAP).

Objectives: The aim of this study was to evaluate the effect of health education adjuvant Proton Pump Inhibitors (PPIs) on diet, lifestyle changes, KAP, GERD clinical symptoms impact scale and severity of the endoscopy. To further explore the predictors of difference on GERD impact scale.

Methods: This study design was a Randomized Controlled Trial (RCT) with 6-8 weeks follow-up. A total of 181 subjects with GERD were randomly assigned to experimental (N=92) or control group (N=89). Data were collected from the structured questionnaire survey and upper gastrointestinal endoscopy reports. The questionnaire include demographic, diet habits, lifestyle habits, disease related KAP and modified GERD Impact Scale (mGIS). The experimental group received PPIs therapy adjuvant with health education intervention, while the control group received PPIs therapy and general routine care. All calculations were carried out using SPSS v18.0 statistical software. A p-value <0.05 was considered statistically significant.

Results: The experimental group was siginificant better than control group to avoid or decreased drinking tea, coffee, soup after a meal, eating spicy foods, increased physical activity, increased disease knowledge, attitudes and practice and decreased mGIS. The experimental group ∆mGIS score was siginificant better than control group with avoid or decreased poor diet, lifestyle, improved disease knowledge and practice. The multiple linear regression (stepwise) analysis showed that improved knowledge (β=1.221, t=2.716), sleeping with the bed-head raised (β=0.539, t=12.344) and avoid or decreased eating sweets (β=0.101, t=3.644) were ∆mGIS predictor.

Conclusions: The findings of this study demonstrated that health education intervention adjuvant PPIs can be offered the best way to improve patients’ poor diet, lifestyle, disease related KAP, and reduced degree of clinical symptoms. However, the effects of health education intervention on endoscopy severity of GERD need the further studies or time to oberserve.

本文目錄  I
表目錄   IV
圖目錄   VI
附錄目錄  VII
中文摘要  VIII
英文摘要  X

本文目錄
第一章 緒論 1
 第一節 研究背景 1
 第二節 研究之必要性與重要性 3
 第三節 研究目的 6
第二章 文獻探討 7
 第一節 胃食道逆流疾病之概念 7
 第二節 衛生教育概念 11
 第三節 胃食道逆流疾病危險因子之相關研究 13
 第四節 胃食道逆流疾病之衛生教育介入模式 17
第三章 研究方法與步驟 20
 第一節 研究設計及樣本 20
 第二節 研究對象及場所 22
 第三節 研究架構 24
 第四節 研究假設 25
 第五節 研究變項操作型定義 26
 第六節 研究工具 34
 第七節 研究工具信、效度測試 38
 第八節 資料收集與步驟 39
 第九節 資料處理與分析方法 40
第四章 研究結果 42
 第一節 基線資料分布情形 43
 第二節 衛生教育介入成效分析 61
 第三節 衛教介入前、後兩組各構面改變於改良型GERD影響尺度改變量(∆mGIS)之分析 74
 第四節 衛生教育介入後實驗組∆mGIS之預測因子分析 80
第五章 討論 87
 第一節 胃食道逆流疾病調查基線資料探討 88
 第二節 衛生教育介入成效評估 91
 第三節 衛教介入前、後兩組各構面改變於∆mGIS之差異探討 95
 第四節 衛生教育介入後∆mGIS之預測因子探討 97
第六章 結論與建議 99
 第一節 結論 99
 第二節 建議 101
參考文獻 104
 英文文獻 104
 中文文獻 110

表目錄
表1 洛杉磯食道炎分級(the Los Angeles Classification of Esophagitis) 9
表2 衛生教育內容介紹 37
表3 實驗組與控制組基本人口學特性分布情形 53
表4 實驗組與控制組於前測之飲食習慣分布情形 55
表5 實驗組與控制組於前測之生活習慣或行為分布情形 57
表6 實驗組與控制組於前測之GERD認知、態度與行為分布情形 59
表7 實驗組與控制組於前測之GIS、mGIS及L.A. Grade分布情形 60
表8 mGIS於各L.A. Grade之相關性分布情形 60
表9 GIS於各L.A. Grade之相關性分布情形 60
表10 實驗組與控制組於衛教介入後飲食習慣改變情形 68
表11 實驗組與控制組於衛教介入後生活習慣或行為改變情形 69
表12 實驗組與控制組衛生教育介入前、後GERD認知、態度與行為改變情形 70
表13 實驗組與控制組於衛生教育介入後於∆GERD認知、態度與行為改變情形 70
表14 實驗組與控制組衛生教育介入前、後mGIS改變情形 71
表15 實驗組與控制組於衛生教育介入後∆mGIS及∆L.A. Grade改變情形 71
表16 衛教介入後實驗組與控制組飲食習慣改變於∆mGIS之分析 78
表17 衛教介入後實驗組與控制組生活習慣或行為改變於∆mGIS之分析 79
表18 衛教介入後實驗組與控制組GERD認知、態度與行為提升於∆mGIS之分析 79
表19 實驗組∆mGIS、∆BMI及∆GERD認知、態度與行為之Pearson correlations分析 83
表20 實驗組衛教介入後飲食習慣改變於∆mGIS之分析 84
表21 實驗組衛教介入後生活習慣或行為改變於∆mGIS之分析 85
表22 衛生教育介入後實驗組∆mGIS預測因子之多元逐步迴歸分析 (N=92) 86

圖目錄
圖1 台灣胃食道逆流疾病診斷治療流程圖 10
圖2 研究流程圖 21
圖3 研究架構 24
圖4 衛生教育介入前、後GERD認知分數改變情形 72
圖5 衛生教育介入前、後GERD態度分數改變情形 72
圖6 衛生教育介入前、後GERD行為分數改變情形 73
圖7 衛生教育前、後mGIS分數改變情形 73

附錄目錄
附錄一 問卷內容效度考驗專家名單 附錄一之1
附錄二 胃食道逆流疾病衛生教育單張 附錄二之1
附錄三 人體試驗計畫同意函 (中文) 附錄三之1
附錄四 人體試驗計畫同意函 (英文) 附錄四之1
附錄五 人體試驗受試者同意書 附錄五之1
附錄六 三軍總醫院胃食道逆流疾病調查問卷 附錄六之1
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