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研究生:李仁慈
研究生(外文):Li,Jen-Tzu
論文名稱:慢性腎臟病人身體症狀、睡眠品質 相關因素之探討
論文名稱(外文):The exploration of the relationships among symptoms disturbances、sleep quality in patients with chronic kidney disease
指導教授:黃秀梨黃秀梨引用關係
指導教授(外文):Hwang,Shiow-Li
學位類別:碩士
校院名稱:美和科技大學
系所名稱:健康照護研究所
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:2015
畢業學年度:103
語文別:中文
論文頁數:111
中文關鍵詞:慢性腎臟病身體症狀睡眠品質
外文關鍵詞:chronic kidney diseasephysical symptomssleep quality
相關次數:
  • 被引用被引用:4
  • 點閱點閱:486
  • 評分評分:
  • 下載下載:106
  • 收藏至我的研究室書目清單書目收藏:1
背景:身體症狀及睡眠品質不良對慢性腎臟病人是很困擾的健康問題,身體症狀 及睡眠品質困擾加速疾病的進展及降低生活品質。以往慢性腎臟病人的研究僅限於透析病人的睡眠品質相關因素或身體症狀相關因素,對於尚未透析的慢性腎臟病人身體症狀及睡眠品質相關因素卻少見,因而慢性腎臟病人身體症狀、睡眠品質及其相關因素為相當重要的議題。
目的:探討慢性腎臟病人的身體症狀與睡眠品質及其相關因素。
方法:以立意取樣南部某區域教學醫院之第三期至第五期慢性腎臟病人共195位進行研究。研究工具包括匹茲堡睡眠品質指標量表(PSQI),身體症狀量表(MSAS),以及病歷查閱疾病屬性與最近一個月內生化值。所得資料以SPSS18.0套裝軟體進行統計分析。
結果:慢性腎臟病人身體症狀以難以入眠82%最常見,依序為體力不足53%,疼痛52%,手腳麻痺或刺痛51.5%。身體症狀中以心理症狀得分數最高(0.653,SD±.579),依序為全球窘迫指數(GDI)(0.556, SD±.494)、總身體症狀(TMSAS)(0.470, SD±.357)、生理症狀(0.458, SD±.434)。慢性腎臟病身體症狀影響因素發現:(一)生理症狀方面:女性較男性高(x2=22.833,p=.000)、無職業者較有職業者高(x2=6.446,p=.011)、合併免疫疾病較沒有免疫疾病低(x2=1.042,p=.044)、合併腫瘤較無者(x2=6.775,p=.009)、血比容愈低生理症狀困擾愈高(x2=28.776,p=.00),白蛋白3.5mg/dl以下者較3.5mg/dl以上者高(x2=7.922,p=.005),尿素氮數值愈高生理症狀困擾程度愈高(x2=6.052,p=.049),腎臟病分期愈高生理症狀困擾愈高(x2=6.774,p=.034)。(二)心理症狀方面:女性較男性高(x2=28.578,p=.000),有職業的較無職業者少(x2=4.013,p=.045),合併腫瘤者較沒有者高(x2=10.355,p=.001),當血比容愈低心理症狀困擾愈高(x2=29.239,p=.000) ,鈣10.0mg/dl以上者比10.0mg/dl以下者高(x2=6.103,p=.047),白蛋白3.5mg/dl以下者比3.5mg/dl以上者較高(x2=9.054,p=.003)、尿素氮數值愈高心理症狀困擾程度愈高(x2=9.560,p=.008)。(三)全球窘迫指數(GDI)方面:女性較男性高(x2=23.088,p=.000),有職業較無職業少(x2=4.215,p=.040),合併腫瘤比沒有者高(x2=9.801,p=.002),血比容愈低GDI症狀困擾愈高(x2=41.018,p=.000),白蛋白3.5mg/dl以下者比3.5mg/dl以上者較高(x2=8.470,p=.004),尿素氮愈高全球窘迫指數症狀困擾愈高(x2=11.839,p=.003),腎臟病分期愈高者全球窘迫指數症狀困擾愈高(x2=12.208,p=.002)。(四)總身體症狀(TMSAS)方面:女性較男性高(x2=18.227,p=.000),有職業的較無職業少(x2=7.241,p=.007),合併腫瘤者較無者高(x2=6.086,p=.014),血比容愈低總身體症狀困擾愈高(x2=30.859,p=.000),白蛋白3.5mg/dl以下者比3.5mg/dl以上者較高(x2=11.053,p=.001),尿素氮愈高總身體症狀困擾愈高(x2=8.092,p=.017),腎臟病分期愈高者總身體症狀困擾愈高(x2=10.676,p=.005)。
慢性腎臟病人睡眠品質不良比率高達84.1%,在年齡65歲以上者較以下者差(x2=11.34, P=.001)、女性較男性差別(x2=5.412, P=.020)、身體症狀之生理症狀相對差者較相對好者差(x2=19.663, P=.000)、心理症狀相對差者較相對好者差(x2=22.801, P=.000)、全球窘迫指數症狀相對差者較相對好者差(x2=22.801, P=.000)、總身體症狀相對差者較相對好者差(x2=25.554, P=.000)。
重要預測因子以邏輯式迴歸分析身體症狀與睡眠品質,身體症狀發現,生理症狀方面女性較男性高4.6倍、合併腫瘤者較無腫瘤者高7倍、血比容24-28%者較36%高5.5倍,28-32%者較36%者高3.6倍。心理症狀方面則發現女性比男性高6倍、合併腫瘤者較無腫瘤者高15倍、血比容24-28%者較36%高5倍,28-32%者較36%者高3.5倍。至於全球窘迫指數(GDI)方面女性較男性高4.4倍、合併腫瘤者較無腫瘤者高12.6倍、血比容24-28%者較36%高7倍,28-32%者較36%者高6.6倍。而總身體症狀方面女性比男性高出3.3倍、無職業者比有職業者高2倍、合併腫瘤者較無者高6.2倍、在血比容,24-28%者較36%高4.9倍,28-32%者較36%者高4倍。
睡眠品質之重要預測因子為65歲以上較65歲以下高5倍、女性較男性高4.3倍、生理症狀相對差較相對好者高54倍、心理症狀相對差較相對好者高33倍、GDI症狀相對差較相對好者高34倍、TMSAS症狀相對差較相對好者高35倍。
結論:本研究慢性腎臟病人身體症狀的比率高達44.1%、女性、血比容、白蛋白低,尿素氮、腎臟病分期高者,身體症狀困擾愈高。研究對象睡眠品質不良比率達84.1%,身體症狀困擾愈高、年齡大、女性、合併腫瘤者,其睡眠品質愈差。慢性腎臟病身體症狀及睡眠品質問題值得醫護人員重視,提供慢性腎臟病人相關照護及諮詢,鼓勵病人積極治療,降低身體症狀及睡眠品質的困擾相當重要。

Background: Adverse physical symptoms and poor sleep quality torment the patients with chronic kidney disease (CKD) and also accelerate progress of the chronic kidney disease. Previous studies of the chronic kidney disease patients is limited to investigate the quality of sleep-related factors or physical symptoms-related factors in dialysis patients, but the studies for pre-dialysis patients are rare. So, to study out the physical symptoms, sleep quality and related factors in chronic kidney disease patients is very important.
Purposes: The exploration of the relationships among symptoms disturbances、sleep quality in patients with chronic kidney disease
Methods:Purposive sampling of a total 195 patients with chronic kidney disease stage 3-5 in a regional teaching hospital in the southern Taiwan. The research instruments included the Pittsburgh Sleep Quality Index scale (PSQI), Memorial Symptom Assessment Scale (MSAS), reviewing medical records for disease property and biochemical parameters within the last month. The resulting data are statistically analyzed with SPSS18.0 software package.
Results: Difficult to sleep (82%) is the most common physical symptoms in chronic kidney disease patients, followed by weakness (53%), physical pain (52%), numbness or tingling of limbs (51.5%). Psychological symptoms have the highest score (0.653, SD ± .579) in physical symptoms, followed sequentially by global distress index (GDI) (0.556, SD ± .494), Total MSAS score (TMSAS) (0.470, SD ± .357), and physical symptoms (0.458, SD ± .434). Physical symptoms of chronic kidney disease factor found:(Ⅰ) Physiological symptoms The factors of physical symptoms : sex (women >men, x2=22.833, p=.000), jobs (non-employed > employed, x2=6.446, p=.011), immune diseases (without immune diseases > with immune diseases, x2=1.042, p=.044), tumors (those combined with tumor> those without tumor, x2=6.775, p=.009), lower hematocrit (x2=28.776, p=.00), lower albumin level( less than 3.5mg/dl > more than 3.5mg/dl, x2=7.922, p=.005), higher blood urea nitrogen values (x2=6.052, p=.049), advanced stage of chronic kidney disease (x2=6.774, p=.034). (Ⅱ)The factors of psychological symptoms included: sex (women> men, x2=28.578, p=.000), jobs (non-employed > employed, x2=4.013, p=.045), tumors (those combined with tumor> those without tumor, x2=10.355, p=.001), lower hematocrit (x2=29.239, p=.000), higher calcium level (more than 10.0 mg/dl> less than 10.0 mg/dl, x2=6.103, p=.047), lower albumin level( less than 3.5mg/dl > more than 3.5mg/dl, x2=9.054, p=.003), and higher blood urea nitrogen values (x2=9.560, p=.008).(Ⅲ) Global Distress Index (GDI) : the women than in men (x2=23.088, p=.000) , non-employers (x2=4.215, p=.040), those with tumor (x2=9.801, p=.002), those with lower the hematocrit (x2=41.018, p=.000), whose albumin< 3.5mg/dl (x2=8.470, p=.004), those with higher blood urea nitrogen(x2=11.839, p=.003), and those with advanced stage of chronic kidney disease (x2=12.208, p=.002). (Ⅳ)Total msas (TMSAS) : the women than in men (x2=18.227,p=.000), those without jobs (x2=7.241, p=.007), those combined with tumor (x2=6.086, p=.014), those with lower hematocrit (x2=30.859, p=.000), whose serum albumin<3.5mg / dl (x2=11.053,p=.001), those with higher blood urea nitrogen(x2=8.092, p=.017), and those with advanced stage of chronic kidney disease(x2=10.676, p=.005).
The prevalence of poor sleep quality in chronic kidney disease patients is 84.1% and poorer sleep quality are noted in whose age>65(x2=11.34, p=.001), women (x2=5.412, p=.020), those with poor physical symptoms (x2=19.663, p=.000), those with more psychological symptoms (x2=22.801, p=.000), those with a higher global distress indices (x2=22.801, p=.000) and those with poor total body symptoms (x2=25.554, p=.000).
Important predictors of Logic regression analysis physical symptoms and sleep quality formula, physical symptoms found revealed the significant predictors of Physiological symptoms are sex (4.6 times higher in women than men), tumor (7.2 times higher in those combined with tumor than those without tumor), hematocrit ( Hct: 36% as reference group, 5.5 times higher in those with Hct 24-28%, 3.57 times higher in those with Hct 28-32%). The predictors of psychological symptoms are sex ( 6 times higher in women), tumor (15 times higher in those combined with tumor), hematocrit (Hct: 36% as reference group, 5 times higher in Hct 24-28% group, 3.5 times higher in Hct 28-32% group) . Global Distress Index (GDI) showed 4.35 times higher in women than men, 12.6 times higher in those combined with tumor than those without tumor, 6.95 times higher in whose Hct 24-28% group than 36% group, 6.6 times higher in whose Hct 28-32 % group than 36% group. Total msas reveal 3.274 times higher in women than men, 2.143 times higher in non-employers than employer, 6.162 times higher in those combined with tumor than those without tumor, 4.9 times higher in Hct 24-28% group than 36% group,4 times higher in Hct 28-32% group than 36% group.
The significant predictors of sleep quality are age (5 times higher in Age>65 than <65), sex (4.3 times higher in women than men), physical symptoms (54 times higher in relatively poor group than relatively good group, psychological symptoms (33 times higher in relatively poor group than relatively good group, GDI Symptoms (34 times higher in relatively poor group than relatively good group, TMSAS (35 times higher in relatively poor group than relatively good group.
Conclusion: This study disclosed 44.1% chronic kidney disease patients have physical symptoms and higher in females, lower hematocrit, lower albumin, higher blood urea nitrogen, and advanced stage of chronic kidney disease . There are 84.1% of chronic kidney disease patients have poor sleep quality and higher in those with more physical symptoms, old age, female, those combined with tumor. The physical symptoms and sleep problems of chronic kidney disease patients deserve medical attention, and provide related care and consultation to encourage patients to attend treatment, reduce physical symptoms and get better sleep quality.

目錄
中文摘要........Ⅰ.
英文摘要........Ⅳ
致 謝.......Ⅶ
目 錄…………………Ⅷ
圖表目錄…………………Ⅹ
附 件…………………….VI
第一章 緒論
第一節 研究動機與背景…....1
第二節 研究目的…………....2
第二章 文獻探討
第一節 慢性腎臟病………...3
第二節 睡眠品質…………...8
第三節 慢性腎臟病人的睡眠品質…..13
第四節 身體症狀……………………..14
第五節 慢性腎臟病人的身體症狀….17
第六節 慢性腎臟病人睡眠與身體症狀的關係……21
第三章 研究方法
第一節 研究設計………………22
第二節 研究架構……………22
第三節 研究假設……………23
第四節 名詞界定……………24
第五節 研究對象……………...........26
第六節 研究工具…………………...27
第七節 資料分析方法……………...30
第八節 研究對象權利維護………...31
第四章 結果
第一節 慢性腎臟病人基本資料………….……………......32
第二節 慢性腎臟病人基本資料與身體症狀的關係.…......42
第三節 慢性腎臟病人基本資料與睡眠品質的關係…......56
第四節 慢性腎臟病人身體症狀與睡眠品質的關係…......59
第五節 慢性腎臟病人身體症狀及睡眠品質之重要預測因子…...60
第五章 討論...............67
第六章 結論與建議
第一節 結論………………………………………………….73
第二節 研究結果應………………………………………….73
第三節 研究限制…………………………………………….74
第四節 未來研究方向..............75
參考文獻……………………………………………………...76

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