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研究生:劉德樂
研究生(外文):Te-Le Liu
論文名稱:思覺失調症患者服用第二代抗精神病藥物之中醫體質研究
論文名稱(外文):思覺失調症患者服用第二代抗精神病藥物之中醫體質研究
指導教授:鄭睿芬鄭睿芬引用關係
學位類別:碩士
校院名稱:中國醫藥大學
系所名稱:護理學系碩士班
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:2016
畢業學年度:104
語文別:中文
論文頁數:110
中文關鍵詞:思覺失調症代謝性症候群第二代抗精神病藥物中醫體質
外文關鍵詞:SchizophreniaMetabolic syndromeSecond-generation antipsychoticsBody constitutionTraditional Chinese Medicine
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本研究主要目的在於探討使用第二代抗精神病藥物之思覺失調症患者的中醫體質、使用第二代抗精神病藥物之思覺失調症患者合併代謝性症候群的中醫體質及使用第二代抗精神病藥物之思覺失調症患者中醫體質與代謝性症候群的相關性。採橫斷式相關性研究設計,研究對象為中部某精神科慢性病房思覺失調症患者,服用第二代抗精神病藥物達半年以上者240位。資料收集包含中醫體質問卷、個人屬性、代謝性症候群相關資料及服用第二代抗精神病藥物種類。資料分析採SPSS 20.0版本進行描述性及推論性統計。
研究結果顯示240位思覺失調症患者的中醫體質,分別為平和質111人(46.3%)、陰血虛99人(41%)、陽氣虛100人(42%)、痰濕瘀滯74人(31%)。陽氣虛體質與自覺壓力感受(OR, 1.12; 95% CI, 1.029-1.218)、自覺健康分數(OR, 0.962; 95% CI, 0.946-0.979)有顯著相關;痰濕瘀滯體質與自覺壓力感受(OR, 1.126; 95% CI, 1.031-1.229)、自覺健康分數(OR, 0.954; 95% CI, 0.936-0.972)、活動量(OR, 0.048; 95% CI, 0.207-0.804)有顯著相關。240位使用第二代抗精神病藥物之思覺失調症患者合併有代謝性症候群(含3項及以上)者有34人(14.2%),其中醫體質分別為陰血虛體質者9人(26%)、陽氣虛體質者10人(29%)、痰濕瘀滯體質者9人(26%)。代謝性症候群(含3項及以上)者在壓力感受及偏頗體質的平均得分均低於代謝危險因子正常者(五項指標均在正常範圍內)。
服用Clozapine患者中,痰濕瘀滯體質者在自覺無運動習慣者和護理人員評估屬輕度活動量者均顯著比非痰濕瘀滯體質者為多。因此,基於本研究發現,建議服用第二代抗精神病藥物之思覺失調症患者,當自覺健康分數低於60分或自覺壓力感受高於2分時需監測中醫體質,並針對偏頗體質者做適當調理措施。服用Clozapine藥物治療者,需特別注意有無痰濕瘀滯體質發生,並針對有痰濕瘀滯體質者衛教指導增加活動量。再者,精神科醫療人員須評估並提供服用第二代抗精神病藥物的患者代謝症候群的相關知識。對於服用第二代抗精神病藥物患者,需監測及控制好代謝症候群中任何一個指標,以降低偏頗體質的發生,並且在照顧服用第二代抗精神病藥物患者時,應評估中醫體質狀態,及早發現偏頗體質,提供體質調理措施。


This study aimed to explore the traditional Chinese medicine body constitution of patients treated with second-generation antipsychotics who had schizophrenia alone or combined with metabolic syndrome, as well as the relationship between metabolic syndrome and traditional Chinese medicine body constitution in patients with schizophrenia who were treated with second-generation antipsychotics. A cross-sectional and correlational study design was used. A total of 240 participants were treated with second-generation antipsychotics for at least 6 months at the Area Psychiatry Hospital in central Taiwan. Data were collected through a traditional Chinese medicine body constitution questionnaire. Personal, metabolic syndrome laboratory, and second-generation antipsychotic use data were also collected. The data were analyzed using SPSS version 20.0 to obtain descriptive and inferential statistics.
The results showed that the body constitutions of the 240 patients included 111 (46.3%) classified as gentleness, 99 (41%) as Yin-Xu, 100 (42%) as Yang-Xu, and 74 (31%) as phlegm stasis. The Yang-Xu constitution was significantly associated with the perception of stress (OR , 1.12; 95% CI, 1.029–1.218) and health (OR, 0.962; 95% CI, 0.946–0.979). The phlegm-stasis constitution was significantly associated with the perception of stress (OR, 1.126; 95% CI, 1.031–1.229), perception of health (OR, 0.954; 95% CI, 0.936–0.972), and physical activity (OR, 0.048; 95% CI, 0.207–0.804). Of the total participants, 34 also had metabolic syndrome (matching three or more conditions). Among these participants, 9 (26%) were classified as having Yin-Xu constitution, 10 (29%) as Yang-Xu, and 9 (26%) as phlegm stasis. The participants with schizophrenia combined with metabolic syndrome (matching three or more conditions) had a lower mean value for the perception of stress and lower total scores of Yin-Xu, Yang-Xu, and phlegm stasis than of those without metabolic syndrome (normal for five medical conditions).
The participants who were treated with clozapine and had a phlegm-stasis constitution had significantly less physical exercise and activity than those without a phlegm-stasis constitution. Based on these research findings, several suggestions were provided. For participants treated with second-generation antipsychotics with a perception of health score <60 and perception of stress score >2, body constitution should be evaluated to identify imbalances in it and provide interventions. Participants treated with clozapine should be evaluated for body constitution , especially phlegm-stasis constitution, and should be advised to increase physical activity. In addition, health providers should evaluate patients treated with second-generation antipsychotics for metabolic syndrome and provide information about this condition. Metabolic syndrome (five medical conditions) should be monitored and controlled in patients treated with second-generation antipsychotics to avoid body constitution imbalances. In addition, health interventions should be provided for patients with imbalanced body constitution.


中文摘要------------------------------------------------------------------------Ⅰ
英文摘要------------------------------------------------------------------------Ⅲ
目錄----------------------------------------------------------------------------Ⅵ
圖表目次------------------------------------------------------------------------Ⅷ
第一章 緒論--------------------------------------------------------------------1
第一節 研究動機與背景-----------------------------------------------------------1
第二節 研究問題-----------------------------------------------------------------3
第三節 研究目的-----------------------------------------------------------------3
第二章 文獻查證----------------------------------------------------------------5
第一節 思覺失調症與代謝症候群的介紹---------------------------------------------5
第二節 中醫體質的涵意及中醫體質量表---------------------------------------------9
第三節 代謝性疾患相關的中醫體質研究現況-----------------------------------------13
第三章 研究方法----------------------------------------------------------------14
第一節 研究設計-----------------------------------------------------------------14
第二節 研究架構-----------------------------------------------------------------14
第三節 名詞界定-----------------------------------------------------------------15
第四節 研究問題-----------------------------------------------------------------17
第五節 研究假設及統計方法-------------------------------------------------------18
第六節 研究場所與對象-----------------------------------------------------------19
第七節 研究工具-----------------------------------------------------------------20
第八節 研究步驟-----------------------------------------------------------------21
第九節 資料統計與分析-----------------------------------------------------------23
第十節 研究倫理-----------------------------------------------------------------24
第四章 研究結果----------------------------------------------------------------25
第一節思覺失調症患者之個人屬性、代謝症候群相關資料及中醫體質狀態分佈------------25
第二節 思覺失調症患者中醫體質與代謝性症候群之相關分析---------------------------27
第三節 中醫體質的相關因素之分析-------------------------------------------------29
第四節服用不同的第二代抗精神病藥物的中醫體質與個人屬性和代謝症候群相關資料之相關因素分析-----30
第五章 討論---------------------------------------------------------------------34
第一節 研究對象中醫體質之分析---------------------------------------------------34
第二節 研究對象有無代謝性症候群與中醫體質之分析---------------------------------36
第三節 使用不同第二代抗精神病藥物與中醫體質之分析-------------------------------39
第六章 結論與建議---------------------------------------------------------------42
第一節 結論---------------------------------------------------------------------42
第二節 護理上之應用-------------------------------------------------------------44
第三節 研究限制-----------------------------------------------------------------46
參考資料------------------------------------------------------------------------86
中文部份--------------------------------------------------------------------86
英文部分--------------------------------------------------------------------90
附錄
附錄一 中醫體質量表-------------------------------------------------------------103
附錄二 中醫體質量表使用授權書---------------------------------------------------109
附錄三 人體試驗委員會同意書-----------------------------------------------------110



圖表目次 頁數
一、圖
圖 3-2-1 研究架構圖----------------------------------------------------------------------------14
圖 3-6-1 研究進行步驟流程圖--------------------------------------------------------------------23
圖 4-1-1 思覺失調症患者之中醫體質分佈----------------------------------------------------------48
二、表
表 3-3-1 代謝症候群----------------------------------------------------------------------------15
表 3-5-1 研究假設及統計方法--------------------------------------------------------------------18
表4-1-1 思覺失調症患者之中醫體質與個人屬性及相關因素分佈和卡方檢定-----------------------------49
表4-1-2 思覺失調症患者之中醫體質與代謝症候群相關資料及相關因素分佈和卡方檢定-------------------51
表 4-1-3 思覺失調症患者的中醫體質與個人屬性之獨立t檢定-----------------------------------------52
表4-1-4 思覺失調症患者的中醫體質與代謝症候群相關資料之獨立t檢定--------------------------------53
表4-2-1 思覺失調症患者有代謝症候群危險因子之中醫體質狀態及相關因素分佈和獨立t檢定--------------54
表 4-2-2 思覺失調症患者有代謝性症候群(含3項危險因子)之中醫體質狀態及相關因素分佈和獨立t檢定----55
表 4-2-3 代謝危險因子正常者與代謝症候群(含3項及以上)之獨立t檢定--------------------------------56
表 4-3-1 影響有無陰血虛體質因素之單變項羅吉斯迴歸分析------------------------------------------57
表 4-3-2 影響有無陽氣虛體質因素之單變項羅吉斯迴歸分析------------------------------------------58
表 4-3-3 影響有無痰濕瘀滯體質因素之單變項羅吉斯迴歸分析----------------------------------------59
表 4-4-1 單純使用一種第二代抗精神病藥物患者之次數分配表----------------------------------------60
表 4-4-2 思覺失調症患者服用Clozapine藥物之中醫體質與個人屬性及相關因素分佈和卡方檢定-----------61
表 4-4-3 思覺失調症患者服用Clozapine藥物之中醫體質與代謝症候群相關資料及相關因素分佈和卡方檢定-63
表 4-4-4 思覺失調症患者服用Clozapine藥物的中醫體質與個人屬性之獨立t檢定----------------------------64
表 4-4-5 思覺失調症患者服用Clozapine藥物的中醫體質與代謝症候群相關資料之獨立t檢定------------------65
表 4-4-6 思覺失調症患者服用Olanzapine藥物之中醫體質與個人屬性及相關因素分佈和卡方檢定--------------66
表 4-4-7 思覺失調症患者服用Olanzapine藥物之中醫體質與代謝症候群相關資料及相關因素分佈和卡方檢定----68
表 4-4-8 思覺失調症患者服用Olanzapine藥物的中醫體質與個人屬性之獨立t檢定---------------------------69
表 4-4-9 思覺失調症患者服用Olanzapine藥物的中醫體質與代謝症候群相關資料之獨立t檢定-----------------70
表 4-4-10 思覺失調症患者服用Risperidone藥物之中醫體質與個人屬性及相關因素分佈和卡方檢定-------------71
表 4-4-11 思覺失調症患者服用Risperidone藥物之中醫體質與代謝症候群相關資料及相關因素分佈和卡方檢定---73
表 4-4-12 思覺失調症患者服用Risperidone藥物的中醫體質與個人屬性之獨立t檢定--------------------------74
表 4-4-13 思覺失調症患者服用Risperidone藥物的中醫體質與代謝症候群相關資料之獨立t檢定----------------75
表 4-4-14 思覺失調症患者服用Amisulpride藥物之中醫體質與個人屬性及相關因素分佈和卡方檢定-------------76
表 4-4-15 思覺失調症患者服用Amisulpride藥物之中醫體質與代謝症候群相關資料及相關因素分佈和卡方檢定---78
表 4-4-16 思覺失調症患者服用Amisulpride藥物的中醫體質與個人屬性之獨立t檢定--------------------------79
表 4-4-17 思覺失調症患者服用Amisulpride藥物的中醫體質與代謝症候群相關資料之獨立t檢定----------------80
表 4-4-18 思覺失調症患者服用Zotepine藥物之中醫體質與個人屬性及相關因素分佈和卡方檢定----------------81
表 4-4-19 思覺失調症患者服用Zotepine藥物之中醫體質與代謝症候群相關資料及相關因素分佈和卡方檢定------83
表 4-4-20 思覺失調症患者服用Zotepine藥物的中醫體質與個人屬性之獨立t檢定-----------------------------84
表 4-4-21 思覺失調症患者服用Zotepine藥物的中醫體質與代謝症候群相關資料之獨立t檢定-------------------85


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