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研究生:蕭子晴
研究生(外文):HSIAO,TZE-CHING
論文名稱:帕金森氏症之睡眠情形與生活品質相關性探討:以社區為基礎之病例對照暨介入性研究
論文名稱(外文):Association Between Sleep Situation and Quality of Life in Patients with Parkinson's Disease: A Community-based Case-control Study and Randomized Controlled Trial.
指導教授:周雨青周雨青引用關係
指導教授(外文):CHOU,YU-CHING
口試委員:周雨青孫建安李俊泰
口試委員(外文):CHOU,YU-CHINGSUN,CHIEN-ANLEE,JIUNN-TAY
口試日期:2016-05-13
學位類別:碩士
校院名稱:國防醫學院
系所名稱:公共衛生學研究所
學門:醫藥衛生學門
學類:公共衛生學類
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:114
中文關鍵詞:帕金森氏症睡眠障礙生活品質神門穴位
外文關鍵詞:Parkinson's diseaseSleep DisordersQuality of LifeShen Men point
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摘要

研究背景:帕金森氏症是一種複雜的神經病變疾病,臨床病症常伴隨有睡眠問題等情形,這些非運動障礙症狀會導致身心不適,進而影響健康和生活品質。其常見的睡眠困擾有失眠(入睡困難、睡眠中斷、清晨早醒)及日間嗜睡等問題。睡眠障礙可藉由藥物及輔助醫療方式(運動、針灸、中藥及穴位指壓等)獲得改善。經過去文獻指出,神門穴位按壓有助於改善睡眠品質。

研究目的:(一)探討帕金森氏症與睡眠情形、生活品質之間的關聯性 (二)探討穴位按壓對於改善睡眠障礙及生活品質的成效。

研究方法:本計畫採二階段不同的研究設計方式同時進行。第一階段,以病例-對照研究設計方式,從彰化某醫院門診選取符合篩選條件的帕金森氏症患者 80 位作為病例組,同時自社區選取無罹患帕金森氏症的住民 135 位作為對照組,並完成主觀性睡眠品質評估量表、帕金森氏症評估工具以及世界衛生組織生活品質量表等結構式問卷量表;第二階段,進一步從第一階段已篩選出符合條件的病例組 80 位,以區集隨機分配的方式,區分為實驗組及對照組,實驗組以彈性腕帶連續施予神門穴位按壓,對照組則配戴無按壓療效的彈性腕帶,持續 8 週±1 週後停止按壓,並於介入前後各完成一次主觀的睡眠問卷及帕金森氏症生活品質量表並搭配客觀的腕動計觀察病患一星期的睡眠品質狀況。

研究結果:帕金森氏症患者與白天嗜睡、睡眠品質差、失眠情形的勝算比各為3.50(95%C.I=1.47,8.33)、2.56(95%C.I=1.19,5.54)、3.41(95%C.I=1.62,7.21)。在生活品質的部分,發現帕金森氏症病患在生理範疇、心理範疇、社會範疇及環境範疇平均分數會比一般族群少 1.84 分、1.56 分、1.09 分及 1.09 分。經過了 8 週±1 週的神門穴位按壓後,其在睡眠情形方面,發現實驗組在睡眠效率的改善情形較對照組好,在其他睡眠變項及生活品質方面則無發現較顯著的改善效果。

結論:根據本研究結果可以得知,帕金森氏症患者其各項睡眠情形及生活品質較一般族群差,但其睡眠效率可經由 8 週±1 週的神門穴位按壓後獲得改善。

關鍵字:帕金森氏症、睡眠障礙、生活品質、神門穴位
Abstract

Background: Parkinson’s disease (PD) is a complex neurodegenerative disorder. The non-motor symptoms of the disease such as sleep disorders have a significant impact on patients' well-being and quality of life. The majority of patients suffer from sleep disturbances affecting their ability to fall asleep, ability to stay asleep or day-time somnolence. Sleep disorders can be treated with medication, physical therapy, acupuncture or acupressure. Studies have suggested the efficacy of acupressure therapy in sleep regulation.In particular, acupressure at the HT-7 (Shen Men) point seems to have a therapeutic effect in individuals with disorders of initiating and maintaining sleep.

Objectives: The study aims were to assess (i) the relationships between sleep disorders and quality of life among patients with PD, (ii) the efficacy of Shen Men point acupressure system to treat sleep disorders in patients with PD.

Methods: There were two stages of the study design. First, a total of 80 patients with PD and 135 healthy subjects without PD were included in a case-control study. In this case-control study, sleep disorders were evaluated by the PSQI score, ESS score and, AIS score. In addition, WHOQOL-BREF and H&Y scale were also collected. Second, a randomized clinical trial (RCT) based on 80 patients with PD affected by sleep disorders were conducted. A device known as the elastic wristband was used to improve
symptoms related to sleep disturbances in the treated group. Secondary outcomes included sleep disorders and quality of life.

Results: The odds ratios of sleep disorders based on the PSQI score, ESS score, and AIS score were 3.50(95% C.I=1.47,8.33), 2.56(95% C.I=1.19,5.54) and 3.41(95% C.I=1.62,7.21), respectively. As for the quality of life, the four WHOQOL-BREF domains for PD were 1.84, 1.56, 1.09 and 1.09 points, respectively, which were lower than the normal values.

Conclusion: The results showed that the qulity of life and the sleep quality of patients with PD were poor than normal subjects. However, it was improved by acupressure at the HT-7 (Shen Men) point for eight weeks.

Key words: Parkinson's disease, Sleep Disorders, Quality of Life, Shen Men point
目錄
表目錄......................................................................................................................... III
附錄目錄..................................................................................................................... IV
摘要............................................................................................................................... V
Abstract ...................................................................................................................... VI
第一章、 緒論 ............................................................................................................. 1
第一節 研究背景與重要性.................................................................................... 1
第二節 研究動機.................................................................................................... 2
第三節 研究目的.................................................................................................... 3
第二章、 文獻探討 ..................................................................................................... 4
第一節 帕金森氏症................................................................................................ 4
第二節 睡眠障礙.................................................................................................... 7
第三節 生活品質.................................................................................................. 10
第四節 神門穴位按壓.......................................................................................... 12
第五節 帕金森氏症與睡眠障礙及生活品質之相關性...................................... 13
第六節 穴位按壓對於改善睡眠障礙及生活品質之相關性.............................. 14
第三章、 研究材料與方法 ....................................................................................... 15
第一節 研究設計.................................................................................................. 15
第二節 研究架構.................................................................................................. 16
第三節 研究對象及篩選條件.............................................................................. 18
第四節 評估工具.................................................................................................. 20
第五節 統計分析.................................................................................................. 26
第四章、 研究結果 ................................................................................................... 27
第一節 第一階段受試者基本人口學、生活型態及慢性疾病分布情形.......... 27
第二節 帕金森氏症患者及一般族群之睡眠品質分布情形.............................. 29
第三節 帕金森氏症患者及一般族群之生活品質分布情形.............................. 31
第四節 帕金森氏症與睡眠情形之相關性分析.................................................. 32
第五節 帕金森氏症與生活品質之相關性分析.................................................. 35
第六節 第二階段受試者資料.............................................................................. 39
第七節 第二階段睡眠情形前後測...................................................................... 40
第八節 第二階段生活品質前後測...................................................................... 42
第五章、 討論 ........................................................................................................... 43
第一節 睡眠情形的相關因子.............................................................................. 43
第二節 生活品質的相關因子.............................................................................. 45
第三節 帕金森氏症與各種睡眠情形相關性之探討.......................................... 47
第四節 帕金森氏症與生活品質相關性之探討.................................................. 49
第五節 神門穴位按壓改善睡眠情形之成效...................................................... 50
第六節 神門穴位按壓改善生活情形之成效...................................................... 52
第七節 研究限制.................................................................................................. 53
第六章、 結論與建議 ............................................................................................... 54
壹 結論.................................................................................................................. 54
貳 建議.................................................................................................................. 55
參考文獻...................................................................................................................... 56
附錄.............................................................................................................................. 85
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1. 姚開屏 (2002)。健康相關生活品質概念與測量原理之簡介。臺灣醫學,6(2),183-192。
2. 洪麗棻、羅美芳 (1997)。一位帕金森氏症老年患者住院期間的衝擊與因應行爲。護理雜誌,44(4),81-86。
3. 馬素華 (1998)。穴位點壓法簡介。長庚護理, 9(3), 85-90.
4. 梁玉雯、蔣欣欣、李從業、吳玫勳、嚴小燕、崔翔雲 (1997)。慢性精神病患者客觀生活品質這探討。護理研究,5(3),212-222。
5. 陳玉黛、張元玫、白其卉 (2006)。穴位按壓應用於神經科便秘病患之成效初探。實證護理,2(4),301-310。
6. 陳美妃、王秀紅 (1995)。老年婦女睡眠品質及其相關因素。護理研究,3(4),323-334。
7. 陳夏蓮、吳子卿、李薇莉、梁天麗 (2006)。慢性阻塞性肺疾病患生活品質相關因素。臺灣醫學,10(3),309-318。
8. 陳麗麗、王純娟、蔡秀珠 (1998)。穴位按摩法對部腹產後促進腸蠕動療效之初探。護理研究,6(6),526-534。
9. 曾亭芸、陳惠敏、黃鳳嬌、蔡素雲、林淑君、王儷蓉 (2014)。穴位指壓對血液透析患者之疲憊感、睡眠品質與生活品質之成效。臺灣腎臟護理學會雜誌,13(2),1-18。
10. 葉家豪 (2009)。睡眠障礙針灸療法的實證研究。北市中醫會刊,15(1),39-49。
11. 黎俊彥、吳家碧 (2002)。本校 89 級大一女學生健康體適能與睡眠品質之相關研究。育達研究叢刊(3),175-184。
12. 鍾文慎、張新儀、石曜堂、溫啟邦 (2003)。國人自覺心理健康: 2001年國民健康訪問調查結果。臺灣公共衛生雜誌,22(6),465-473。
 
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