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研究生:李佳謀
研究生(外文):Lee, Chia-Mou
論文名稱:影響社區第2型糖尿病居民出現周邊神經血管病變相關因素之探討
論文名稱(外文):Factors Associated with Peripheral Neurovasculopathy Among Rural Community Residents with Type 2 Diabetes
指導教授:陳美燕陳美燕引用關係
指導教授(外文):Chen, Mei-Yen
口試委員:張長正郭素娥
口試委員(外文):Chang, Chang-ChengGuo, Su-Er
口試日期:2012-07-04
學位類別:碩士
校院名稱:長庚科技大學
系所名稱: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:2012
畢業學年度:100
語文別:中文
論文頁數:84
中文關鍵詞:第2型糖尿病糖尿病足周邊神經病變周邊血管病變
外文關鍵詞:Type 2 Diabetes MellitusDiabetic foot ulcerPeripheral neuropathyPeripheral vasculopathy
相關次數:
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  • 下載下載:91
  • 收藏至我的研究室書目清單書目收藏:1
背景:糖尿病足是常見的糖尿病人慢性合併症,糖尿病足部潰瘍是造成下肢重大截肢的主要因素,而截肢後將造成身體失能、心理障礙及龐大社會醫療成本的支出。約四分之一的糖尿病人會發生足部潰瘍,是造成糖尿病人接受截肢和住院治療最常見的原因,許多研究指出糖尿病周邊神經病變(Peripheral neuropathy, PN)和周邊血管病變(Peripheral vasculopathy, PV)是導致糖尿病足部潰瘍的主因;另外,糖尿病人有嚴重足部血管阻塞出現截肢和死亡的風險較高,須接受截肢機率是非糖尿病人高8倍以上;其中約5%的截肢病人需接受重大截肢,30%以上的截肢病人需再次截肢,且再截肢平均為2.48次。大部分糖尿病人處於症狀不明顯的糖尿病臨床症狀前期,常於接受篩檢才被診斷而大大增加合併症發生的風險。但透過積極的糖尿病足風險管理,很多足部潰瘍或截肢的問題是可以避免的,有研究結果指出早期診斷與治療能讓85%的糖尿病人避免截肢,規律且仔細的足部檢查並提供糖尿病人適當的衛教,是預防足部病變最符合經濟效益的方法。
目的:本研究目的在了解社區第2型糖尿病(Type 2 diabetes mellitus, T2DM)居民出現足部周邊神經血管病變(Peripheral neurovasculopathy, PNV)的盛行率,及探討影響社區T2DM居民出現PNV的相關因素。
方法:本研究採橫斷式相關性研究設計,自2011年2月至2012年6月,以立意取樣方式在嘉義縣18鄉鎮衛生所進行各衛生所造冊列管個案的收案工作。研究工具有結構式問卷(人口學屬性、生理狀況、健康行為及第2型糖尿病患健康促進生活量表(DMHP量表))及足部生理評估工具(密西根神經病變篩檢量表(Michigan Neuropathy Screening Instrument, MNSI)、踝臂指數測量儀(Ankle Brachial Index, ABI)、足部脈搏觸診(Foot pulse pressure, FPP))。當MNSI、ABI及FFP任一結果為異常時,本研究定義為PNV。本研究以SPSS for Windows 18版之統計軟體進行統計分析,以計數、百分比、最大/最小值、平均值及標準差、卡方檢定(Chi-square test)、t檢定(t-test)及對數迴歸(logistic regression)進行統計與分析。
結果:參與本研究的個案共有404位,以女性個案居多(55.2%);周邊神經病變佔34.5%、周邊血管病變佔17.1%及足部脈搏觸診異常佔12.4%,而整體的PNV異常率則為48.6% (188人)。在人口學屬性方面,PNV個案的年齡顯著高於無PNV個案(t= -4.86, P< .001),居住在沿海區個案出現PNV顯著多於平地區及山區個案(χ²= 25.68, P< .001)。健康狀況方面,PNV個案的空腹血糖(Fasting blood glucose, FBG)顯著高於無PNV個案(t= -2.60, P= .01);PNV個案的糖化血色素(HbA1c)顯著高於無PNV個案(t= -2.16, P= .03),另外,PNV個案在利用運動控制血糖的行為顯著低於無PNV個案(χ²= 4.89, P= .03)。健康行為方面,PNV個案的平均DMHP分數顯著低於無PNV個案(t= 4.07, P< .001)。最後以logistic regression分析影響PNV的相關因素,在控制潛在干擾因子後發現較高的年齡(OR= 2.46, 95% CI, 1.55~3.92; P< .001)、居住在沿海地區(P< .001)、較高的HbA1c (P< .01)及低DMHP行為得分(P< .01)是PNV的重要獨立預測因素。
結論:本研究結果顯示,社區第2型糖尿病居民有周邊神經病變和血管病變的高盛行率、居民普遍血糖控制差、健康行為及足部保護行為不足及健康促進行為偏低。本研究結果可提供社區照護運用非侵入性足部檢測工具,檢測糖尿病足部周邊神經病血管病變問題,協助醫護人員確認足部周邊神經病血管病變的高危險個案,並提供個案適當的轉介與治療,以降低糖尿病足部潰瘍與截肢的盛行率。

Background: Diabetic foot is a common chronic diabetic complication. Diabetic foot ulcer is the major cause of low limb amputation, and amputation causes physical disability, mental disorders and higher costs of social and medical care. About a quarter of diabetes patients suffer from diabetic foot ulcer which is the most common cause for patients to accept amputation and hospitalization. Many studies have indicated that diabetic peripheral neuropathy (PN) and peripheral vasculopathy (PV) are major causes of diabetic foot ulcers. In addition, patients with serious foot vessel occlusion are at higher risk of amputation and death, and have to accept amputation eight times higher than non-diabetes. About 5% of amputation patients require a major amputation, more than 30% of amputation patients require re-amputation, and the average amputation frequency is 2.48. Most of the diabetes patients are in preclinical phase with asymptomatic, not being diagnosed until the screening, then the risk of diabetic complications greatly increases. However, through an active diabetic foot risk management, many problems of foot ulcers and amputations can be avoided. Some studies conclude that early diagnosis and treatment can avoid 85% diabetic amputation, regular and careful foot examination and appropriate diabetes health education is the most cost-effective methods for prevention of foot lesions.
Aims: The purpose of this study was to evaluate the prevalence and associated risk factors of peripheral neurovasculopathy (PNV) among rural community residents with type 2 diabetes.
Methods: A cross-sectional descriptive correlation research design was conducted on the participants with type 2 diabetes mellitus managed in each of the 18-township health centers in Chiayi County from February 2011 to June 2012. Data were collected with a semi-structured questionnaire, including demographic attributes, health status, health related behaviors, scale of health promotion for diabetes mellitus (DMHP scale) and foot physiological evaluation instrument such as Michigan Neuropathy Screening Instrument (MNSI), ankle-brachial index (ABI) and foot pulse pressure (FPP). PNV was defined by abnormal MNSI, abnormal ABI, or abnormal FFP. SPSS software for windows version 18 was applied to analyze the data through descriptive statistic, chi-square, t-test, and logistic regression analyses.
Results: A total of 404 patients participated in this study. More than 55% of participants were female, and 74.5% of the participants received less education below six years. Approximately 32.2%, 17.1% and 12.4% participants with PN, PV and abnormal FFP were detected, and an overall PNV prevalence was 46.5% (n= 118) in this study. In demographic attributes, the average age of PNV was significantly higher than non-PNV (t= -4.86, P< .001); the prevalence of PNV in coastal region was significantly higher than that in plains and mountains region (χ²= 25.68, P< .001). In health status, fasting blood glucose (FBG) (t= -2.60, P= .01) and HbA1c (t= -2.16, P = .03) of PNV participants were significantly higher than that of non-PNV ones; exercise for glycemic control of PNV participants was significantly lower than that of non-PNV ones (χ²= 4.89, p= .03). In health related behaviors, the average DMHP scores of PNV participants was significantly lower than that of non-PNV ones. Finally, logistic regression analysis showed that the important independent predictors for PNV were associated with older age (OR= 2.46, 95% CI, 1.55~3.92; P< .001), participants living in coastal region (P< .001), higher HbA1c (P< .01), and lower DMHP scores (P< .01).
Conclusions: The results of this study showed that the prevalence of peripheral neuropathy and vasculopathy were both high among community type 2 diabetes residents. Most residents were poor in glycemic control, lacking in health behavior, foot protection behavior and health-promotion behaviors. Furthermore, the results of this study might provide community care with non-invasive foot assessment instruments to detect peripheral neurovasculopathy, help medical staff confirm the high-risk patients of foot peripheral neurovasculopathy lesions, and give appropriate referrals and treatment to decrease the prevalence of diabetic foot ulcers and amputations.

致謝辭 I
中文摘要 II
ABSTRACT IV
目錄 VI
圖表目錄 VIII
統計結果表格 IX
第一章 緒論 - 1 -
第一節 研究動機與重要性 - 1 -
第二節 研究目的 - 3 -
第二章 文獻查證 - 4 -
第一節 糖尿病的流行病學探討 - 4 -
第二節 糖尿病理想控制指標及照護之探討 - 9 -
第三節 糖尿病足部病變 - 13 -
第四節 糖尿病足部病變評估工具 - 17 -
第三章 研究方法 - 25 -
第一節 研究架構 - 25 -
第二節 研究假設 - 26 -
第三節 名詞界定 - 26 -
第四節 研究設計 - 27 -
第五節 研究對象 - 27 -
第六節 研究工具及測量方法 - 28 -
第七節 研究過程 - 32 -
第八節 資料分析 - 33 -
第四章 研究結果 - 35 -
第一節 人口學屬性、健康狀況及健康行為分析 - 35 -
第二節 出現足部周邊神經血管病變現況分析 - 36 -
第三節 影響出現足部周邊神經血管病變之相關性分析 - 37 -
第四節 出現足部周邊神經血管病變的重要預測因子 - 43 -
第五章 討論與建議 - 44 -
第一節 社區T2DM居民的PNV盛行率高 - 44 -
第二節 沿海地區的居民容易出現PNV的問題 - 45 -
第三節 社區T2DM居民糖尿病控制普遍不佳 - 47 -
第四節 社區T2DM居民健康習慣及足部保護行為不足 - 49 -
第五節 社區T2DM居民執行健康促進行為較低 - 51 -
第六章 結論與研究限制 - 54 -
第一節 結論 - 54 -
第二節 研究限制與建議 - 55 -
參考文獻 - 57 -
統計結果表格 - 68 -
附錄 - 77 -

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