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研究生:吳珮甄
研究生(外文):Pei-Chen Wu
論文名稱:血液透析中的運動方案對病人身體功能及生活品質之成效
論文名稱(外文):The Effect Of An Intradialytic Exercise Intervention On Physical Function And Quality Of Life for hemodialysis patients
指導教授:陳金彌陳金彌引用關係
指導教授(外文):Chin-Mi Chen
口試委員:陳金彌洪思群朱基銘
口試委員(外文):Chin-Mi ChenSzu-Chun HungChi-Ming Chu
口試日期:2013-05-31
學位類別:碩士
校院名稱:國防醫學院
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:2013
畢業學年度:101
語文別:中文
論文頁數:113
中文關鍵詞:血液透析中運動身體功能生活品質血液透析
外文關鍵詞:intradialytic exercise,physical functionquality of lifehemodialysis
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中文摘要
【目的】運動可以減輕疲憊、憂鬱、焦慮的情緒,並可以穩定生理現象,但台灣相關研究較少也未將運動指導納入常規血液透析病人指導,因此本研究目的為:探討透析中運動方案對透析病人身體活動功能及生活品質之成效。
【方法】本研究採類實驗研究設計,以雙組前、後測的測量方法,使用透析中運動方案為介入措施。研究計畫將於北部某區域醫院執行,自2013年3月到5月,以方便取樣方式進行收案。實驗組每週接受3次,每次30分鐘的透析中運動,共8週,透析中運動方案,並且在透析中的前三個小時內執行完成,對照組則維持原來治療。本測量時機為介入措施(透析中運動方案)實施前及8週後介入措施(透析中運動方案)結束後。
本研究所使用的研究工具,IQOLA SF-36生活品質量表(台灣版本)以及測量五次起坐時間、十次起坐時間、一分鐘起坐次數以及六分鐘步行時間。本研究使用SPSS Windows 18.0 版套裝軟體進行建檔與統計分析。所使用的統計方法包括描述性統計與推論統計。
【結果】本研究共有實驗組43人及對照組43人,兩組之基本屬性具有同質性。研究對象的年齡分布是 41 歲到 85 歲,實驗組的平均年齡為63.7歲,對照組則為65.6歲。實驗組以及對照組僅有18.6%和20.9%有工作;50%有規律動習慣。原發疾病以糖尿病居首位,實驗組與對照組各占51.2%與39. 5%。本研究顯示:接受運動方案的研究對象其身體功能與生活品質具顯著成效,一分鐘起-坐次數(t = 2.158, p< .05);6公尺步行時間(F =9.157 , p< .05),接受運動方案的研究對象較未接受者顯著縮短時間及提升速度;生活品質的身體健康狀態分數(t = 3.245,p< .05),接受運動方案的研究對象較未接受者顯著得分增加。
【結論】由研究結果可推論,透析中運動方案即被動運動可以協助血液透析病人部分提升生活品質及增進身體功能;透過本研究的成效,可推行到各個醫療院所及提供各單位建立常規照護模式作為資料參考。本研究為單一研究,未來仍須要進行多單位的大規模研究,以了解透析中運動的安全性及其成效。

關鍵字:血液透析中運動、身體功能、生活品質、血液透析。

Abstract
[Purpose] Exercise benefits for hemodialysis patients as it does for the general population ; however , exercise programs have not yet become routine clinical practice in Taiwan . In particular , few studies have explored the effect of an intradialytic exercise intervention on hemodialysis patients inTaiwan. Therefore, the purpose of this study was to
examine the effects of an intradialytic exercise intervention on physical function and quality of life for hemodialysis patients.
[Methods] This quasi-experimental, pretest-posttest study was conducted in a hemodialysis unit at a local hospital in northern Taiwan. Convenience sampling was used to recruit adults participants (aged more than 20 years ) who had received hemodialysis for 3 months. Data were collected from March to May 2013. Participants in the experimental group received an intervention consisting of intradialytic exercise three times per week for 8 weeks. The participants in the comparison group received usual nursing care.Tests were performed at two time points : before and after the intervention.The outcome indicators were time to complete five sit-to-stand cycles (STS-5), time to complete 10 sit-to-stand cycles (STS-10), repetition of sit-to-stand cycles in 1 minute (STS-60), gait speed , and scores on the Short Form-36 Taiwan version (SF-36). All data were analyzed using SPSS/WINDOW S 18.0 statistical software.The statistical methods included descriptive statistics , and inferential statistics.
[Results] Participants(N=86) were divided into experimental
groups (n=43), and comparison groups (n=43) after informed consenr. Both groups were homogenous in terms of demographic chacacteristics . All participants were between 41and 85years old.The mean age was 63.7 years in the experimental group, and 65.6 years old in the other. In term of employment , a minority of participants were employed; 18.6% in the experimental group, and 20.9% in the comparison group. Half of the participants exercised regularly. In the experimental group, 51.2% had diabetes mellitis , the major cause of end stage renal disease , in the comparison group , 39. 5% had diabetes mellitis. Significant differences in physical function and quality of life were identified.The experimental group showed a significant improvement from pretest to posttest in STS-60 scores (t = 2.158, p< .05) and gait speed (F =9.157 , p< .05) . In terms of SF-36 scores , the Physical Component Scale score increased (t = 3.245,p< .05) , and the Mental Component Scale scores did not differ significantly .
[Conclusions] In conclusion, intradialytic exercise improved physical function and quality of life for hemodialysis patients . The results of this study suggest that intradialytic exercise can be implemented in health organizations and medical hospitals as an established hemodialytic nursing intervention .This study was limited by being conducted in a single unit.Further multi sites studies are needed to understand and verify the safety and effectiveness of intradialytic exercise .
Keywords: intradialytic exercise, physical function, quality of life, hemodialysis.

目 錄
頁數

目錄……………………………………………………………… I
表目錄…………………………………………………………… III
圖目錄…………………………………………………………… IV

附錄目錄……………………………………………………… V

中文摘要………………………………………………………… VI

英文摘要………………………………………………………… VIII

第一章 緒論
第一節 研究動機與重要性…………………………… 1
第二節 研究目的………………………………………… 4
第三節 名詞界定……………………………………… 5
第二章 文獻查證
第一節 血液透析對病人的影響………………… 6
第二節 血液透析病人的身體功能………………… 13
第三節 血液透析病人的生活品質………………… 16
第四節 運動對血液透析病人之影響……………… 21
第三章 研究方法
第一節 研究架構…………………………………… 28
第二節 研究假設……………………………………… 30
第三節 研究設計………………………………………… 31
 第四節 研究對象及場所………………………………… 34
第五節 研究工具………………………………………… 36
第六節 資料收集過程…………………………………… 39
第七節 資料分析方法……………………………………… 42
第八節 倫理考量………………………………………… 44
第四章 研究結果
第一節 研究對象基本屬性………………………… 45
第二節 研究對象前後測的身體功能及生活品質… 52
第三節 實驗組與對照組研究對象在前後測的差異分析 54
第四節 透析中運動方案的成效…………………… 57
第五節 基本屬性、身體功能及生活品質的關聯性 60
第六節 介入措施實施過程與紀錄…………………… 64
第五章 討論
第一節 研究對象基本變項……………………… 68
第二節 運動方案對研究對象身體功能及生活品質成效 71
第六章 結論、建議與限制
第一節 結論……………………………………… 73
第二節 建議與限制……………………………… 75

表目錄

頁數
表3-1實驗組與對照組介入措施比較表………………………… 33
表3-2研究目的及研究假設與統計方法對照表………………… 43
表4-1研究對象基本屬性之描述統計及同質檢定…………… 48
表4-2研究對象身體狀況與疾病分布之描述統計及同質檢定 49
表4-3研究對象日常運動習慣調查之描述統計及同質檢定… 51
表4-4實驗組與對照組在前後測身體功能及生活品之同質檢定 53
表4-5實驗組與對照組之前後測身體功能及生活品質差異分析 56
表4-6運動方案對兩組身體功能及生活品質變化的比較……… 58
表4-7連續型基本屬性及血液生理指標與生活品質相關係數表 61

圖目錄

頁數
圖3-1研究架構…………………………………………………………… 29
圖3-2實驗設計圖………………………………………………………… 32
圖3-3資料收集流程圖……………………………………………… 40
圖4-1 6公尺步行時間在二組的散布情形及組內迴歸線……… 59



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