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研究生:林緯
研究生(外文):Wei Lin
論文名稱:藥物與心理社會介入對男性更年期勃起功能障礙與憂鬱情緒之成效:系統性回顧暨統合分析
論文名稱(外文):Effectiveness Evaluation of Pharmacology and Psychosocial Intervention on Erectile Dysfunction and Depression Mood in Andropause syndrome: A Systematic Review and Meta Analysis
指導教授:謝佳容謝佳容引用關係
指導教授(外文):Chia-Jung Hsieh
口試委員:張玨劉介宇
口試委員(外文):Chueh ChangChieh-Yu Liu
口試日期:2014-07-30
學位類別:碩士
校院名稱:國立臺北護理健康大學
系所名稱: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:129
中文關鍵詞:男性更年期勃起功能障礙憂鬱症心理社會介入藥物介入
外文關鍵詞:andropauseerectile dysfunctiondepressionpsychosocial interventionpharmacology intervention
相關次數:
  • 被引用被引用:1
  • 點閱點閱:476
  • 評分評分:
  • 下載下載:50
  • 收藏至我的研究室書目清單書目收藏:3
背景:隨著醫療的進步,對於男性更年期的議題仍不常見,男性更年期也會如同女性出現熱潮紅、焦躁不安、憂鬱、早洩及勃起功能等問題,但男性不同與女性的是,其荷爾蒙是慢慢減退,不同與女性有停經的狀況,故多數的男性不認為此為更年期症狀,就醫也較難啟齒,大多數就醫民眾多以藥物介入做為治療首選,但更年期是一個過程並非一種疾病,故是否只有藥物治療才是有效治療,用系統性回顧的方式做為統整。
目的:主旨為探討藉由心理社會合併藥物或單純藥物治療對於男性更年期勃起功能障礙與憂鬱情緒的改善情形,有益於維護男性更年期的健康或提供男性更年期的症狀緩解方法。
方法:本研究使用系統性文獻回顧與統合分析法,搜尋1993年至2013年12月的中英文文獻,搜尋的資料庫分別為:Airitilibrary華藝線上圖書館(CEPS思博網);CETD中文碩博士論文資料庫;CJTD中國大陸學術期刊暨學位論文;而國外資料庫則為CINAHL、PubMed、MEDLINE、Journal of Sex & Marital Therapy、ProQuest及The Cochrane Library共九個資料庫,在憂鬱症狀部分使用系統性文獻回顧而勃起功能部分則運用統合分析來探討不同的介入方式對於國際勃起功能指標量表(International Index of Erectile Function;IIEF)的實用性。
結果:在憂鬱症狀部分,結果顯示除藥物介入外,在心理社會部分,運動為主要搜尋的介入措施,其內容包含有氧運動、氣功、增強肌耐力,而心理治療師的介入及飲食大多都可以改善其症狀,而在評斷勃起功能部分,在介入後整體IIEF的結果其異質性分析並不達統計上顯著差異(P = 0.0750)。而使用三種介入方式後對於勃起功能(Erectile Function)及整體滿意度(overall Satisfaction)的評估其異質性分析結果分別為 (P < 0.0001),其標準化平均差95%CI為1.989 to 3.809及(P < 0.00001) 其95%CI為1.758 to 3.417達統計上的顯著差異。結果顯示不同的介入方式單評估勃起功能及整體滿意度是有顯著的,但若看整體的分數卻是無顯著,可能的原因收案的篇數少,較無法代表全部,對於評估的量表在評值個案時建議報表以細項呈現更能彰顯量表的實用性。
結論:在男性更年期憂鬱症狀及勃起功能問題,除了藥物治療之外,都可以藉由心理社會介入來改善更年期不適的症狀,更年期問題並非疾病,應避免單一藥物的治療,避免過度醫療化的情形。

Background: Although with the advancement in medicine in recent years, the topic of male menopause, andropause, is still rarely studied and discussed. Similar to female menopause, andropause exhibits many symptoms such as hot flash, irritability and anxiety, depression, premature ejaculation, and erectile dysfunction. However, andropause differs from females, whereby the male hormone is reduced gradually and without acute symptoms such as the absence of periods. Therefore, the majority of men do not think they are experiencing menopausal symptoms and are reluctant in seeking medical advice. The majorities of andropause were treated with pharmacology interventions. However since menopause is a process and not a disease, andropause medications require a systemic literature review to elucidate their necessity and effectiveness.
Purpose: The purpose of this study was to compare the effectiveness between a combination of psychosocial therapy and pharmacology interventions and medication alone in treating andropause caused erectile dysfunction and depression. The result of this research can be of benefit to maintain health and relief symptoms for andropause.
Method: Systematic review and meta-analysis of literatures was employed in this study. Both Chinese and English related literatures, published between 1993 and the December of 2013, were analyzed. The reviewed Chinese databases include: Airiti library (Chinese Electronic Periodicals Service [CEPS]), Chinese Electronic Theses and Dissertation Service (CETDS), and the Chinese Journal and Thesis Database (CJTD). The reviewed English database include: Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, MEDLINE, Journal of Sex and Marital Therapy, ProQuest, and the Cochrane Library. A systematic review of andropause literature was performed with focuses on depression symptoms. Erectile functions were investigated with metal-analysis to determine the effectiveness, measured by International Index of Erectile Function (IIEF), of each different treatment method.
Result: The results in andropause depression symptoms showed that apart from pharmacology interventions, exercise treatments such as cardiovascular exercise, Qigong, strength training were used as the main psychosocial treatment. Furthermore, psychotherapies and dietary interventions can also improve the symptoms of depression. The results showed that there was no significant correlation between overall intervention and the overall IIEF through heterogeneity analysis (P = 0.0750). However, after each of the three different treatments, the erectile function (P < 0.0001; 95% confidence interval [CI] = 1.989 to 3.809) and overall satisfaction (P < 0.00001; 95%CI = 1.758 to 3.417) scores were shown to be significantly correlated to IIEF. The results indicated that the different intervention methods, when assessed separately, showed significant correlations to erectile function and overall satisfaction. However, when the methods were assessed together, the overall score did not show a significant correlation. A possible reason for this phenomenon is that the number of sampled literatures is very few, and thus cannot elucidate an overall relationship. Finally, we also suggest that when using the IIEF index in assessing cases in a study, the detailed list assessed items should be listed to demonstrate of the index’s practicality.
Conclusion: In addition to pharmacology interventions, psychosocial interventions can be used in improving andropause related depression and erectile dysfunction. Because andropause is not a disease, treatments of avoided only drug use should be considered to avoid over-medication.

目  次

中文摘要 …………………………………………………………………………… i
英文摘要 …………………………………………………………………………… iii
目次 ………………………………………………………………………………… v
表次 ………………………………………………………………………………… vii
圖次 ………………………………………………………………………………… viii
第一章 緒論
第一節 研究背景與重要性 ……………………………………………………… 1
第二節 研究目的………………………………………………………………… 3
第三節 研究問題 ………………………………………………………………… 3
第二章 文獻探討
第一節 更年期定義 ……………………………………………………………… 4
第二節 男性更年期定義與症狀 …………………………………………………
一、男性更年期的定義 6
二、男性更年期症狀 7
(一)憂鬱症狀……………………………………………………… 9
(二)性功能障礙…………………………………………………… 10
第三節 更年期處置 ………………………………………………………………
一、藥物治療…………………………………………………………… 13
二、心理社會介入……………………………………………………… 17
第四節 實證醫學與護理…………………………………………………………
一、實證醫學與護理的定義…………………………………………… 24
二、實證醫學之步驟…………………………………………………… 25
三、文獻品質之評定…………………………………………………… 25
四、實證臨床證據分類………………………………………………… 26
第五節 統合分析………………………………………………………………… 27
第三章 研究方法
第一節 研究過程 ………………………………………………………………… 32
第二節 研究工具 ………………………………………………………………… 37
第三節 資料分析 ………………………………………………………………… 38
第四章 研究結果與討論
第一節 男性更年期性功能障礙搜尋結果及樣本來源………………………… 39
第二節 統合分析及出版偏差…………………………………………………… 62
第三節 男性更年期性憂鬱症狀搜尋結果及樣本來源………………………… 74
第五章 結論
第一節 男性更年期性功能障礙的文獻回顧…………………………………… 93
第二節 男性更年期憂鬱症狀的文獻回顧……………………………………… 96
第三節 男性更年期治療的醫療化現象………………………………………… 99
第四節 研究對護理實務的應用與貢獻………………………………………… 101
第五節 限制與建議 ……………………………………………………………… 103
參考文獻
中文部分 ………………………………………………………………………… 104
外文部分 ………………………………………………………………………… 111

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