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研究生:黃燕秋
研究生(外文):Yen Chiu Huang
論文名稱:髖骨骨折老年患者術後疼痛強度及疼痛相關生活品質之變化及認知功能之影響
論文名稱(外文):Longitudinal change of postoperative pain intensity and pain-related quality of life and their association with cognitive function in elderly patients with hip fracture
指導教授:徐亞瑛徐亞瑛引用關係
指導教授(外文):Y. I. Shyu
學位類別:碩士
校院名稱:長庚大學
系所名稱:護理學系
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:2014
畢業學年度:102
論文頁數:117
中文關鍵詞:術後疼痛強度疼痛相關生活品質認知功能老年患者髖骨骨折
外文關鍵詞:postoperative pain intensitypain-related quality of lifecognitive functionelderly patientship fracture
相關次數:
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本研究目的為探討髖骨骨折老年患者出院後一年術後疼痛強度與疼痛相關生活品質的變化,以及認知功的影響。本研究為二次資料分析,資料來源採用徐亞瑛博士兩項臨床試驗中的對照組資料,分別為:2001-2003年「針對老人髖關節骨折病人之介入措施模式」及2005-2009年「針對老年髖關節骨折病人之三種照護模式」。原始資料採縱貫性研究(longitudinal study),由台灣北部某醫學中心的髖骨骨折老年病患,以立意抽樣(purposive sampling)的方式選取180位控制組個案。住院期間個案只接受術後常規照護及衛教單張指導,出院後研究人員則會定期訪視,但不提供任何諮詢與介入措施。研究人員運用數字疼痛評估量表(NRS)及修訂版臉部表情疼痛量表(FPS-R)評估個案的術後疼痛強度、SF-36生活品質量表的身體疼痛量表(BP)評估個案的疼痛相關生活品質,以及簡易智能量表(MMSE)評估個案的認知功能,收集個案出院後一、三、六、十二個月術後疼痛強度與疼痛相關生活品質,以及出院前認知功能狀況的資料。應用SPSS19.0 for Windows與廣義估計方程式(GEE)進行資料分析。
研究發現髖骨骨折的老年患者出院後至一年經歷到疼痛及較差的疼痛相關生活品質。個案出院後十二個月仍有15.5%有中重度疼痛與18.6%中重度疼痛干擾。老年髖骨骨折患者出院後至一年術後疼痛強度平均分數由2.22(SD = 2.10)降低至0.98(SD = 1.69),其中以出院後前六個月下降最顯著,第六及第十二個月疼痛強度變化不大。同時,個案的疼痛相關生活品質平均分數由65.64(SD = 25.16)提升至79.79(SD = 24.79),顯示出院後疼痛相關生活品質呈現上升的趨勢,且持續一整年。此外,統計顯示老年髖骨骨折患者術後疼痛強度愈高,則疼痛相關生活品質愈差(β = -8.976, p = .001)。研究同時發現出院前認知功能有障礙的老年患者其術後疼痛強度較認知功能正常的老年患者高(β = .518, p = .034),及出院前認知功能有障礙的老年患者其疼痛相關生活品質較認知功能正常的老年患者差(β= -6.890, p = .018)。
根據本研究發現,提供健康照護者對於髖骨骨折老年患者出院後一年術後疼痛強度及疼痛相關生活品質需付出更多關注並制定適當的介入措施,特別是對於有認知功能障礙的髖骨骨折患者。

The purpose of this study was to investigate the changes of pain intensity and pain-related quality of life, and the influences of cognitive function on these changes during the first year following hip fracture. Secondary data analysis, using data from control groups of two clinical trials conducted by Dr. Shyu on care models for older patients with hip fractured was implemented. The original data were collected longitudinally from participants of a medical center in northern Taiwan. A total of 180 participants of two control groups that only received the usual care during hospitalization without any home rehabilitation were included for the analysis. The pain intensity was assessed using Numeric Rating Scale (NRS) and Faces Pain Scale-Revised (FPS-R), pain related health related quality of life (HRQoL) was assessed using Bodily Pain scale of the 36-Item Short Form Health Survey (SF-36) before the surgery, before discharge, after discharge one, three, six, twelve months following discharge, and the cognitive function was assessed using Mini-Mental State Examination before the discharge . The data was analyzed using generalized estimating equations (GEE).
The results indicate that hip fractured older persons experienced pain and had poor pain related HRQoL even at 12th months following hospital discharge. There were still 15.5% of patients experienced moderate to severe pain and 18.6% had moderate to severe pain interference at 12 months following discharge. They experienced decreased pain intensity from an average of 2.22 (SD = 2.10) to 0.98 (SD = 1.69) from pre-discharge to one year after discharge. The most significant declined occurred during first 6 months and little changes occurred from sixth to twelfth following hospital discharge. At the same time, their pain related HRQoL showed an increased trend throughout the first year following discharge from M = 65.64 (SD = 25.16) to M = 79.79 (SD = 24.79). The higher pain intensity these patients experienced, the lower pain related HRQoL they had (β = -8.976, p = .001). This study also found that those with cognitive impairment before hospital discharge experienced higher pain intensity (β = .518, p = .034) and lower pain-related HRQoL (β= -6.890, p = .018) during the first year following discharge than those without cognitive impairment.
Based on findings of this study, health care providers need to pay attention to post-operative pain and pain related HRQoL for hip fractured older persons during first year following discharge and developed corresponding interventions. Specific attention would need to pay to those hip fractured patients with cognitive impairment.

目錄
指導教授推薦書
口試委員會審定書
誌謝..……………………………………………………………………iii
中文摘要.………………………………………………………….……iv
英文摘要...………………………………………….…………………..vi
目錄.……………………………………………………..…….………viii
圖目錄….....…..………………………………………………….……..xi
表目錄….………………………………………………………….…...xii
第一章 緒論………………………………………………………..……1
第一節 研究重要性及研究動機……………………………….….…1
第二節 研究目的……………………………………………….….…6
第三節 研究假設…………………………………………………..…7
第四節 名詞界定…………………………………………………..…8
第二章 文獻查證…………………………………………………..……9
第一節 疼痛……………………………………………………..……9
第二節 老年髖骨骨折患者術後疼痛強度對疼痛相關生活品質
的影響....…………………………………………………………..…19
第三節 認知功能對老年髖骨骨折患者術後疼痛強度與疼痛相
關生活品質的關係………………………………………………..…23
第三章 研究方法..…………………………………………………..…31
第一節 研究設計…..………………………………….….…………31
第二節 研究架構..………………………………….…….…………32
第三節 研究資料來源及資料收集過程………………..…………..35
第四節 研究工具……………………………………..……………..42
第五節 研究倫理考量 …………………………….….……………49
第六節 資料統計方法 …………………………….…….…………50
第四章 研究結果與分......................................................52
第一節 研究對象基本屬性描述..............................................52
第二節 出院後一年術後疼痛強度與疼痛相關生活品質之變化
.…………………………………………………………………….56
第三節 出院後一年術後疼痛強度與疼痛相關生活品質之相關 性….………………………………………………………….………61
第四節 出院前認知功能正常及認知功能障礙對術後疼痛強度
與疼痛相關生活品質之影響…………………………….……….…63
第五章 討論..…………………………………………………….….…67
第一節 研究對象術後疼痛強度與疼痛相關生活品質的變化情形……………………………………………………………………..68
第二節 研究個案術後疼痛強度與疼痛相關生活品質之相關性…70
第三節 出院前認知功能正常與認知功能障礙個案對術後疼痛強
度與疼痛相關生活品質之影響……………………………….….…71
第四節 研究結果之推論...………………………………………….74
第六章 結論與建議...……………………………………………….…78
第一節 結論.…..…………………………………………………….78
第二節 研究限制.…………………………………………………...79
第三節 建議..…………………………………………………….….80
參考文獻及附錄.…………………………………………………….…82
附錄一 基本資料問卷…..…………………………………………..…98
附錄二 巴氏量表..…………………………………………………..…99
附錄三 簡式智能量表….………………………………………….…100
附錄四 疼痛評量......…………………………………………………101
附錄五 生活品質量表..…...……………………………………….…102

圖目錄
圖3.1 生物心理社會模式........…………………………………………33
圖3.2 研究架構....………………………………………………………34
圖3.3 收案狀況及流失率... ……………………………………………41
圖4.1 術後疼痛強度的變化....…………………………………………57
圖4.2 SF7的變化....…..…………………………………………………58
圖4.3 SF8的變化…..……………………………………………………59
圖4.4 疼痛相關生活品質的變化....……………………………………60
圖4.5 疼痛強度及疼痛相關生活品質之相關性..…..…………………62
圖4.6 出院前認知功能分組與術後疼痛強度之相關性………………65
圖4.7 出院前認知功能分組與疼痛相關生活品質之相關性…………66

表目錄
表3.1資料收集的內容及時間.….……………………………………37
表3.2兩組個案基本屬性同質性檢定結果..…………………………38
表3.3統計方法....……………………………………………………..51
表4.1研究對象基本屬性分佈..………………………………………54
表4.2 GEE分析術後疼痛強度在時間之變化……………………….56
表4.3術後疼痛強度統計結果.......…………………………………56
表4.4疼痛相關生活品質兩題統計結果..……………………………59
表4.5 GEE分析疼痛相關生活品質在時間之變化….………………60
表4.6疼痛相關生活品質統計結果…………………………………..60
表4.7 GEE分析術後疼痛強度與疼痛相關生活品質結果….………61
表4.8 GEE分析術後疼痛強度與疼痛干擾的結果………………62
表4.9 GEE分析出院前認知功能正常組及認知功能障礙組對術後疼痛強度之結果……………………………………………………64
表4.10 GEE分析出院前認知功能正常組及認知功能障礙組對疼痛相關生活品質之結果…………………………………………………65

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