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研究生:林玉菁
研究生(外文):Yu-Ching,Lin
論文名稱:比較藥物治療或藥物併膀胱訓練治療對膀胱過動症婦女之成效探討
論文名稱(外文):The Study on the Different Effectiveness of Drug Therapy or Combination Therapy of Drug and Bladder Training on Women with Overactive Bladder
指導教授:陳鳳櫻陳鳳櫻引用關係
指導教授(外文):Fong-Ying Chen
學位類別:碩士
校院名稱:弘光科技大學
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
畢業學年度:102
語文別:中文
論文頁數:102
中文關鍵詞:藥物治療膀胱訓練膀胱過動症婦女
外文關鍵詞:drug therapybladder trainingoveractive bladderwomen
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目的:本研究目的在探討膀胱過動症婦女接受藥物治療或藥物併膀胱訓練治療對其急尿、日間頻尿、夜尿、急迫性尿失禁、症狀困擾及生活品質之差異情形。
方法:自2012年8月30日至2013年9月30日期間採類實驗性研究設計。以台中某醫學中心婦產門診中診斷為膀胱過動症,並接受一般常規口服膀胱過動症藥物治療之患者為研究對象。將研究對象分派至實驗組34位及控制組35位,實驗組除了接受一般常規口服膀胱過動症藥物之外,另接受10~20分鐘膀胱訓練指導,對照組僅接受一般常規口服膀胱過動症藥物。以結構性式問卷於前測、4週後、8週後及12週後進行資料收集,測量工具含三部分:受試者基本資料、膀胱過動症症狀問卷(Overactive Bladder Symptom Score;OABSS)、膀胱過動症症狀困擾暨生活品質調查問卷(Overactive Bladder Questionnaire;OAB-q)。資料以SPSS 20 for Windows統計軟體進行進行卡方檢定(Chi-square test)、獨立樣本t檢定(independent sample t-test)以及概化方程式(GEE)進行分析比較。
結果:在控制年齡及教育程度之下:一、實驗組之急尿與夜尿於4週後、8週後及12週後其改善差異優於控制組,達顯著改善(all;P<.05),而日間頻尿僅在12週後呈現顯著差異(P<.05),至於急迫性尿失禁在本研究中則未見顯著差異。二、實驗組在症狀困擾上於8週後以及12週後其改善差異優於控制組(both;P<.05)。三、實驗組在生活品質上於4週後、8週後以及12週後其改善差異優於控制組(all;P<.05)四、再將生活品質分為四個部分進行分析,在睡眠方面與關注方面,實驗組於4週後、8週後以及12週後其改善差異顯著優於控制組(all;P<.05),而社交方面及因應方面則在8週後以及12週後才見其改善差異顯著優於控制組(both;P<.05)。
結論:隨著藥物作用,對膀胱過動症的改善有一定的成效,但是若增加膀胱訓練其改善成效會比單純藥物治療更好。

Objective: This study aims to discuss the difference of the effectiveness of drug therapy or combination therapy of drug and bladder training on women with overactive bladder for treating their urgent micturition, daytime frequent micturition, nocturia, urgency urinary incontinence, symptom distress and improving life quality.
Methods: The study adopted quasi-experimental research design from 30 August 2012 to 30 September 2013 and took the patients who were diagnosed with overactive bladder by the maternity clinic of a medical center in Taichung and received conventional oral drugs for treatment of overactive bladder as the study subjects. They were distributed to the experimental group (34 patients) and the control group (35 patients). The former received bladder training guidance for 10 to 20 minutes plus conventional oral drugs, while the latter only received conventional oral drugs for overactive bladder. A structured questionnaire was adopted in the pre-test and after 4 weeks, 8 weeks and 12 weeks to collect data. Measurement tools included three parts, namely, the basic information of the subjects, Overactive Bladder Symptom Score (OABSS) and Overactive Bladder Questionnaire (OAB-q). The study then conducted chi-square test, independent sample t-test and generalized equations (GEE) toward the data through SPSS 20 for Windows statistical software for analysis and comparison.
Results:Under the control of age and education level. First, the improvement of the experimental group in urgent micturition and nocturia after 4 weeks, 8 weeks and 12 weeks was better than that of the control group, which achieved the significant improvement (all; P <.05); daytime frequent micturition only showed significant difference after 12 weeks (P <.05); urgency urinary incontinence showed no significant difference in the present study. Second, the improvement of the experimental group in symptom distress after 8 weeks and 12 weeks was better than that of the control group (both; P <.05). Third, the improvement of the experimental group in life quality after 4 weeks, 8 weeks and 12 weeks was better than that of the control group (all; P <.05).Fourth, it’s found after life quality was divided into four parts for analysis that the improvement of the experimental group in sleep and attention after 4 weeks, 8 weeks and 12 weeks was significantly better than that of the control group (all; P <.05), and the improvement in its social aspects and coping aspects after 8 weeks and 12 weeks was significantly better than that of the control group (both; P <.05).
Conclusion: Drugs have certain effects on the improvement of overactive bladder, but the effectiveness by supplementing bladder training would be better than by simply eating drugs for treatment.

目錄
致謝………………………………………………………………………………………Ⅰ
中文摘要…………………………………………………………………………………Ⅱ
英文摘要…………………………………………………………………………………Ⅲ
目錄………………………………………………………………………………………Ⅴ
附錄………………………………………………………………………………………Ⅷ
表目錄……………………………………………………………………………………Ⅸ
圖目錄……………………………………………………………………………………Ⅹ

第壹章 緒論
第一節 研究背景及重要性……………………………………………………….…1
第二節 研究目的……………………………………………………………….……4
第三節 研究問題與假設………………………………………………………….…5
第四節 名詞界定………………………………………………………………...…..6

第貳章 文獻查證
第一節 正常排尿機轉……………………………………………………………….7
第二節 膀胱過動症之病理機轉及其症狀…………………………………………9
第三節 膀胱過動症之相關影響因素…………………………………………...…10
第四節 膀胱過動症之常見症狀困擾及生活品質之影響……………………..…13
第五節 膀胱過動症之診斷及藥物治療………………………………………...…15
第六節 膀胱訓練相關成效之研究…………………………………………………17




第参章 研究方法
第一節 研究架構………………………………………………………………….…24
第二節 研究設計………………………………………………………………….…25
第三節 研究對象及場所………………………………………………………….…26
第四節 研究變項的定義和測量………………………………………………....…27
第五節 研究工具信、效度檢測…………………………………………………….33
第六節 研究步驟與流程……………………………………………………….……35
第七節 研究對象之倫理考量………………………………………………………38
第八節 資料處理與統計分析……………………………………………....………39

第肆章 研究結果
第一節 膀胱過動症婦女2組之基本屬性及前測資料分析與比較………….……40
第二節 探討膀胱訓練對膀胱過症婦女在前測、4週後、8週後及12週後於急尿之改變差異…………………………………………………………….……49
第三節 探討膀胱訓練對膀胱過症婦女在前測、4週後、8週後及12週後於日間頻尿之改變差異…………………….…………………………………...…52
第四節 探討膀胱訓練對膀胱過症婦女在前測、4週後、8週後及12週後於夜尿之改變差異……………………………………………………………...….55
第五節 探討膀胱訓練對膀胱過症婦女在前測、4週後、8週後及12週後於急迫性尿失禁之改變差異………………………………………………………58
第六節 探討膀胱訓練對膀胱過症婦女在前測、4週後、8週後及12週後於症狀困擾之改變差異……………………………………………………………61
第七節 探討膀胱訓練對膀胱過症婦女在前測、4週後、8週後及12週後於生活品質之改變差異……………………………………………………………64


第伍章 討論
第一節 研究對象之背景因素……………………………………………..………79
第二節 膀胱訓練介入對膀胱過動症婦女急尿、日間頻尿、夜尿、急迫性尿失禁、症狀困擾及生活品質之成效探討………………………………………81
第陸章 結論…………………………………………………………………….……90
第柒章 研究限制與建議………………………………………….……………...91
参考文獻………………………………………………….………………….…….….92













附錄
附錄一 問卷授權同意信函(OABSS)…………………….…………………….102
附錄二 問卷授權同意信函(OAB-q)……………………………..…………….103
附錄三 評鑑問卷內容效度CVI值之專家名單…………………….……………104
附錄四 專家效度檢定結果…………………………………………………………105
附錄五 人體試驗研究計劃許可書……………………………..………….………111
附錄六 人體試驗研究計劃展延許可書………………………..………………....112
附錄七 膀胱過動症調查問卷……………………………………….……………..113
附錄八 對照組衛教單張…………………………………………...………………119
附錄九 實驗組衛教單張………………………………………….…………….….120

















表目錄
表1 研究對象之基本屬性…………………………………….…………………..46
表2-1 兩組膀胱過動症婦女前測、4週後、8週後及12週後於急尿之改變差異(概化估計方程式)………………………………………………………….…50
表3-1兩組膀胱過動症婦女於前測、4週後、8週後及12週後於日間頻尿之改變差異(概化估計方程式)………………………………………………….…53
表4-1兩組膀胱過動症婦女於前測、4週後、8週後及12週後於夜尿之改變差異(概化估計方程式)……………………………………………….…………56
表5-1兩組膀胱過動症婦女於前測、4週後、8週後及12週後於急迫性尿失禁之改變差異(概化估計方程式)…………………………………...….………59
表6-1兩組膀胱過動症婦女於前測、4週後、8週後及12週後於症狀困擾之改變差異(概化估計方程式)………………………………………………..…..62
表7-1兩組膀胱過動症婦女於前測、4週後、8週後及12週後於生活品質之改變差異(概化估計方程式)…………………………………………………….65
表7-2兩組膀胱過動症婦女於前測、4週後、8週後及12週後於睡眠方面之改變差異(概化估計方程式)……………………………………………..….....68
表7-3兩組膀胱過動症婦女於前測、4週後、8週後及12週後於社交方面之改變差異(概化估計方程式)………………………………………………….…71
表7-4兩組膀胱過動症婦女於前測、4週後、8週後及12週後於關注方面之改變差異(概化估計方程式)……………………………………………….……74
表7-5兩組膀胱過動症婦女於前測、4週後、8週後及12週後於因應方面之改變差異(概化估計方程式)………………………………..…..................…..77
表8研究討論之精簡表………………………….………………………………..88




圖目錄
圖一 研究架構圖…………………………………………….……………………..24
圖二 膀胱訓練之研究設計圖………………………………………..……………25
圖三 研究資料收及流程圖…………………………………………………..……37
圖2-1 兩組膀胱過動症婦女前測、4週後、8週後及12週後於急尿之改變差異圖………………………………………………………………..……………....51
圖3-1 兩組膀胱過動症婦女前測、4週後、8週後及12週後於日間頻尿之改變差異圖……………..…………………………………………………......…….54
圖4-1 兩組膀胱過動症婦女前測、4週後、8週後及12週後於夜尿之改變差異圖……………………………………………….………………………………..57
圖 5-1 兩組膀胱過動症婦女前測、4週後、8週後及12週後於急迫性尿失禁之改變差異圖……………………………………….………………………........60
圖6-1 兩組膀胱過動症婦女前測、4週後、8週後及12週後於症狀困擾之改變差異圖…………………………………………………………….……………..63
圖7-1 兩組膀胱過動症婦女前測、4週後、8週後及12週後於生活品質之改變差異圖……………………………………………………………….…………..66
圖7-2 兩組膀胱過動症婦女前測、4週後、8週後及12週後於睡眠方面之改變差異圖………………………………………………………………….………..69
圖7-3 兩組膀胱過動症婦女前測、4週後、8週後及12週後於社交方面之改變差異圖…………………………………………………………………..………..72
圖7-4 兩組膀胱過動症婦女前測、4週後、8週後及12週後於關注方面之改變差異圖…………………………………………………………….…..………….75
圖7-5兩組膀胱過動症婦女前測、4週後、8週後及12週後於因應方面之改變差異圖………………………………………………….…………….……....….78

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