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研究生:張欣梅
研究生(外文):Hsin-May Chang
論文名稱:探討台灣無喉者復聲協會講習班學員吞嚥問題百分比、症狀,以及吞嚥問題對其社交活動和社交參與的影響
論文名稱(外文):A Study of Swallowing Problems Among Members of the Speech Rehabilitation Workshop Under the Association of Laryngectomees, Taiwan: Percentage, Symptoms, and Impact on Social Activities and Social Participation
指導教授:盛華盛華引用關係
指導教授(外文):Sheng-Hwa Chen
口試委員:王亭貴陳素秋
口試委員(外文):Tyng-Guey WangSu-Chiu Chen
口試日期:2013-07-30
學位類別:碩士
校院名稱:國立臺北護理健康大學
系所名稱:聽語障礙科學研究所
學門:醫藥衛生學門
學類:復健醫學學類
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:119
中文關鍵詞:無喉者全喉切除吞嚥社交參與
外文關鍵詞:laryngectomeestotal laryngectomyswallowingsocial participation
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本篇研究目的在調查台灣無喉者復聲協會講習班學員歷經化療、放射線治療、與全喉切除手術等喉癌的治療程序後,無喉者吞嚥問題之百分比、吞嚥不適之症狀,以及吞嚥問題對其社交活動和社交參與的影響為何。
本研究採問卷調查研究方法,依據研究目的,採用國外學者Mclean, Cotton, & Perry (2008) 針對全喉切除者吞嚥狀況編寫的吞嚥症狀問卷,請國內英語領域專家學者翻譯成中文,另請無喉者領域專家學者進行題目建議與修訂,並進行問卷調查。問卷含21項問題,包括受試者基本資料 (年齡與性別)、全喉切除手術相關資料 (手術時間,醫師,醫院)、搭配療程 (放射線治療,化療)、手術後的改變、社交生活的改變以及身體不適的程度。本研究受試者來源為無喉者復聲協會分布於北、中、南的會員,共44位。受試者個人資料與病史分析以描述性統計為主,藉由次數分配和百分比描述影響的發生頻率來呈現受試者問卷回應內容。以Fisher’s exact probability test,探討個人資料、手術相關資料、搭配療程、手術後飲食的改變、以及吞嚥問題症狀變項對於受試者是否自覺有吞嚥問題之影響。再以Pearson correlation coefficient 檢視有吞嚥困難的受試者提供的吞嚥不適程度分數與其在社交活動和社交參與相關題目之答題表現之相關性。
結果顯示,以受試者自評有吞嚥問題之人數作百分比計算,百分比為52.3%;以有吞嚥問題症狀的受試者人數作百分比計算,百分比為79.5%。顯示無喉者吞嚥問題之百分比高於一般民眾。受試者最常見的吞嚥問題症狀為需要改變飲食內容與質地、覺得有東西卡在喉嚨、有咀嚼食物的困難、吞嚥時我會覺得喉嚨緊、感覺有東西堆在喉嚨後面、需要比過去長的時間把東西吞下去、及要喝流質食物沖下固
體食物,這些變項與受試者吞嚥問題有顯著相關。受試者吞嚥問題的不適感對社交活動與社交參與最顯著的影響是讓受試者覺得無法做一些過去能做的事。本研究結果可以提供醫師、放射師、語言治療師在患者的治療與照護上了解無喉者在吞嚥方面可能發生的問題與臨床需求,以擬定改善的方向,降低吞嚥問題對無喉者的生活品質帶來的衝擊。

The primary aim of this study was to investigate the percentage and symptoms of swallowing problems among Taiwanese laryngectomees, as well as its impact on the laryngectomees’ social activities and social participation. A questionnaire by Maclean, Cotton, & Perry (2008) was translated into Mandarin and validated by ENT specialists. The questionnaires were completed by members of the Taiwan Laryngectomy Speech Rehabilitation Association in its branches located in Taipei, Taichung, and Tainan. Data analysis was descriptive, with frequencies and counts being the primary methods of reporting. Fisher’s exact probability test was adopted to compare the differences between subjects with and without self-reported swallowing difficulties in terms of demographics, treatment information, and any noted changes to their ability to swallow following surgery. Pearson correlation coefficient was adopted to determine the effects of the distress associated with swallowing on the laryngectomees’ social activities and social participation satisfaction level. The results showed that 52.3% of the respondents had experienced difficulty with their swallowing since their laryngectomy. 79.5% reported that they had experienced symptoms of swallowing difficulties. The most commonly reported symptoms included: having to make changes to the constitution and consistency to the diet, feeling things stuck in the throat, having difficulty chewing food, and feeling of tightness in the throat during swallowing. The most common complaint on social activities and social participation was that swallowing difficulties prevented the respondents from doing things they used to be able to do. These data were useful for helping surgeons, radiologists, and speech-language pathologists raise awareness of the possible complications that may occur to the laryngectomees’ ability to swallow during treatment and thus these specialists can provide patients with realistic information about postoperative swallowing function and appropriate care.
中文摘要I
英文摘要II
表 次V
圖 次VI
附錄VII
第一章 緒論1
第一節 研究背景與動機2
第二節 研究目的6
第三節 研究問題與研究假設6
第二章 文獻探討8
第一節 正常的吞嚥機制8
第二節 全喉切除對吞嚥功能的影響9
第三節 化學-放射線治療對身體組織和吞嚥的影響13
第四節 全喉切除者的吞嚥對社交和生活品質的影響16
第五節 頭頸部癌症生活品質評估工具之比較18
第三章 研究方法22
第一節 研究架構22
第二節 研究對象24
第三節 研究工具25
第四節 研究步驟28
第五節 資料整理與統計分析32
第四章 研究結果34
第一節 無喉者吞嚥問題的百分比34
第二節 無喉者的個人資料與癌症治療史37
第三節 無喉者吞嚥問題的症狀42
第四節 無喉者的吞嚥問題對其社交活動和社交參與的影響48
第五章 研究討論50
第一節 無喉者吞嚥問題的百分比50
第二節 無喉者的個人資料與癌症治療史53
第三節 無喉者吞嚥問題的症狀56
第四節 無喉者的吞嚥問題對其社交活動和社交參與的影響64
第五節 臨床意義66
第六節 研究限制66
第七節 未來研究的建議67
參考文獻69
中文文獻69
英文文獻71

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