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研究生:吳盈慧
研究生(外文):Ying-Hui Wu
論文名稱:居家型足部水療於中老年糖尿病病人足部潰瘍傷口癒合之改善成效
論文名稱(外文):Effectiveness of Homecare Foot Hydrotherapy on the Improvement of Wound Healing in middle aged and older Patients with Diabetic Ulcer Foot
指導教授:林惠如林惠如引用關係
指導教授(外文):Hung -Ru Lin
口試委員:林寬佳張世幸
口試委員(外文):Kuan-Chia LinShin-Hsin Chang
口試日期:2014-01-20
學位類別:碩士
校院名稱:國立臺北護理健康大學
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:2014
畢業學年度:102
語文別:中文
論文頁數:108
中文關鍵詞:糖尿病足部潰瘍足部水療傷口癒合
外文關鍵詞:DiabetesFoot HydrotherapyFoot UlcerWound Healing
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中老年人口所罹患的慢性病中,以糖尿病盛行率最高。其中糖尿病足部病變引發潰瘍、感染及截肢等問題,為糖尿病人者住院、殘障和死亡的重要原因之一。
本研究的目的為探討居家型足部水療於中老年糖尿病病人足部潰瘍傷口癒合、足部神經感覺、足部血液循環、傷口疼痛感、傷口癒合滿意度之改善成效。研究採二組(實驗組及對照組)前後重複測量之設計,於北部某醫學中心收案,研究對象為醫師診斷為糖尿病足部潰瘍無感染之中老年病人,研究工具包括:單股尼龍纖維檢測足部神經感覺、踝肱動脈壓指數檢測足部血液循環、電腦免費影像分析軟體(ImageJ)評估工具、數字型疼痛評分量表、病人主動提供癒合滿意度。資料收集從收案後T0到T8每週一次為期二個月,共9次,以SPSS 20.0英文版軟體進行描述性和概似化估計方程式分析(Generalized Estimated Equation;GEE)。
本研究共收案24位糖尿病足部潰瘍病人,平均年齡70.7歲,罹患糖尿病平均為8.9年,傷口分類以缺血最多,佔87.5%。研究結果顯示,實驗組與對照組病人潰瘍傷口癒合、足部神經感覺、傷口疼痛感、自覺傷口癒合滿意度情形皆隨時間進展呈顯著改善,介入期間實驗組比對照組傷口平均多縮小413.66 mm2,
但兩組之間未達顯著差異。足部神經感覺,實驗組比對照組平均多上升1.33點,兩組之間達顯著差異。足部血液循環,實驗組比對照組ABI比值平均多上升0.06,兩組之間未達顯著差異。傷口疼痛感,實驗組比對照組平均多下降1.00分,兩組之間達顯著差異。自覺傷口癒合滿意度,實驗組比對照組平均多上升3.33,兩組之間達顯著差異。
足部水療是一項不具侵入性、副作用少且操作簡單之傷口照護方式,建議可用於糖尿病足部潰瘍病人之傷口照護,以促進傷口癒合、延緩周邊神經病變症狀及幫助肌肉放鬆及促進局部血液循環,並可降低換藥時的疼痛感及增加滿

Among the chronic diseases contracted by middle-aged and elderly populations, diabetes has been the most prevalent. In addition, ulcers, infections, and amputations related to diabetic foot neuropathy are the primary causes of hospitalization, disability, and mortality among patients with diabetes.
The objective of this study was to explore the effectiveness of home-based foot hydrotherapy on foot ulcer wound healing, foot neural sensation, foot blood circulation, wound pain, and healing satisfaction of middle-aged and elderly patients with diabetes. This study adopted a pretest‒posttest repeated measures design for the experimental and control groups. Middle-aged and elderly patients diagnosed with noninfected diabetic foot ulcers were recruited from a medical center in Northern Taiwan. The research instruments used included a monofilament nylon test for evaluating foot neural sensation, the ankle brachial index (ABI) for testing foot blood circulation, the free image analysis software ImageJ, a numeric pain rating scale, and patient perceived healing satisfaction. Once the participants were recruited, the data were collected once per week for 2 months (T0–T8). The English version of the SPSS 20.0 program was used to conduct descriptive and generalized estimated equation analyses.
In this study, the participants were 24 patients with diabetic foot ulcers. The average age of the participants was 70.7 years, and they have experienced diabetes for an average of 8.9 years. Most of the participants experienced ischemic ulcers (87.5%). The results indicated that gradually, ulcer wound healing, foot neural sensation, wound pain, and perceived wound healing satisfaction greatly improved in both the experimental and control groups. During the intervention period, the wounds of the participants in the experimental group shrank by an average of 413.66 mm2 more than that of the control group, but no significant difference was observed. Regarding foot neural sensation, the average scores of the experimental group increased by 1.33 compared with the control group, demonstrating a significant difference. Concerning foot blood circulation, the ABI ratio of the experimental group increased by 0.06 more compared with the control group, but no significant difference was observed. The average wound-pain score decline in the experimental group was 1.00 point lower than that in the control group, exhibiting a significant difference. According to the test for perceived healing satisfaction, the average score increase among the participants in the experimental group was 3.33 higher than that among the control group, indicating a significant difference.
Foot hydrotherapy is a noninvasive and easy-to-operate wound-caring method that involves few side effects. We recommend using this method for treating the wounds of patients with diabetic foot ulcers, thereby facilitating wound healing, postponing peripheral neuropathy symptoms, promoting muscle relaxation, and enhancing local blood circulation. Furthermore, performing foot hydrotherapy can also reduce the pain during dressing changes and increase patient satisfaction.

中文摘要 i
英文摘要 ii
目次 iii
表次 v
圖次 vii
第一章 緒論 1
第一節 研究背景與動機 1
第二節 研究目的 4
第三節 研究問題 4
第四節 研究假設 4
第五節 名詞界定 5
第二章 文獻探討 8
第一節 糖尿病流行病學及併發症 8
第二節 糖尿病人足部潰瘍之病理生理學、治療與預後 9
第三節 傷口的癒合及護理 19
第四節 糖尿病足在傷口照護的相關研究 25
第五節 足部水療治療的相關概念 27
第三章 研究方法 31
第一節 研究架構 31
第二節 研究設計 31
第三節 研究對象 32
第四節 研究工具及信效度檢定 33
第五節 研究步驟 38
第六節 研究倫理 40
第七節 資料處理與統計分析 41
第八節 預期研究限制 43
第四章 研究結果 44
第一節 研究對象基本資料之分布情形 44
第二節 組別介入前在各研究變項之前測同質性 47
第三節 本研究之介入結果成效 50
第五章 討論 66
第一節 研究樣本的特性 66
第二節 足部水療介入對糖尿病足潰瘍傷口癒合相關變項成效探討 67
第六章 結論、研究限制與應用建議 73
第一節 結論 73
第二節 研究限制 75
第三節 應用與建議 76
參考文獻 78
中文部份 78
英文部份 80
附錄 89
附錄一 參與研究同意書 89
附錄二 足部潰瘍傷口相關檢測評估表 93
附錄三 實驗組與對照組足部傷口每週進展圖示 96


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