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研究生:吳宜容
研究生(外文):WU, I-JUNG
論文名稱:口腔照護對接受C型肝炎抗病毒治療患者之成效
論文名稱(外文):Effects of Oral Care for Hepatitis C Patients Receiving Antiviral Treatment
指導教授:陳美燕陳美燕引用關係
指導教授(外文):CHEN, MEI-YEN
口試委員:張德生黃淑倫陳美燕
口試委員(外文):CHANG, TE-SHENGHUANG, SHU-LUENCHEN, MEI-YEN
口試日期:2017-06-30
學位類別:碩士
校院名稱:長庚科技大學
系所名稱:護理系碩士在職專班
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:2017
畢業學年度:105
語文別:中文
論文頁數:81
中文關鍵詞:口腔照護C型肝炎抗病毒治療口腔健康行為
外文關鍵詞:Oral CareHepatitis CAntiviral TreatmentOral Health Behaviors
相關次數:
  • 被引用被引用:0
  • 點閱點閱:192
  • 評分評分:
  • 下載下載:20
  • 收藏至我的研究室書目清單書目收藏:1
背景:C型病毒性肝炎會造成人類肝硬化與肝癌,目前尚無疫苗可以預防。所幸已經有成效不錯的抗病毒治療,其治療方式主要以長效干擾素合併雷巴威林為主。治療過程常產生口腔不適的症狀,若加上全身性副作用的問題出現時,常使患者忽略執行口腔衛生行為;另外醫護人員也容易忽略指導病患口腔衛生的工作,因此患者產生口腔不適與發炎現象加劇,此時可能影響食慾和免疫力,甚至導致患者放棄持續接受抗病毒治療。提供口腔照護是護理專業的重要任務,其主要好處是減少口腔潰瘍、增加口腔舒適感與完治率。經由系統性回顧發現,國內外應用口腔照護措施於C型肝炎抗病毒治療患者之研究相當不足。研究目的:探討口腔照護措施對於接受C型肝炎抗病毒治療患者,治療期間執行口腔衛生之成效,包括口腔健康觀念、口腔健康行為與口腔健康狀態之改變。研究方法:本研究採類實驗、單組前後測設計,以結構式問卷,面對面訪談收集人口學資料、口腔健康行為及口腔健康狀態。口腔照護執行時間每位患者維持三個月,實驗前後收集患者口腔健康行為、口腔健康狀態與牙菌斑指數之變化。研究工具包括牙菌斑指示劑與口腔照護教材。以SPSS 22版統計軟體分析,描述性統計以人數、百分比、平均值、標準差及最大/最小值;推論性統計以McNemar及廣義估計方程式(generalized estimating equation, GEE)檢定。研究結果:共34位來自南部某區域醫院內科門診,符合收案條件之患者參與本研究,其平均年齡50歲(SD=11, 21~76),女性占55.9%。結果顯示口腔照護介入後,參與者在刷牙次數(p<.001)、使用牙線或牙間刷習慣(p<.01)與口腔舒適狀況(p<.001)有顯著改善;在口腔健康得分方面,介入後第一個月(β= -1.559, p<.001)、第二個月(β= -2.074, p<.001)及第三個月(β= -2.251, p<.001),都較介入前有顯著改善;在牙菌斑指數方面,介入後第一個月(β= -1.732, p<.001)、第二個月(β= -2.120, p<.001)及第三個月(β= -2.490, p<.001),也都較介入前有顯著進步。結論:整體而言,口腔照護介入可改善C型肝炎患者接受抗病毒治療期間所引起的口腔不適症狀,也能改善口腔健康行為與口腔健康狀態。口腔照護是一項簡單、低成本的照護措施,患者可方便在家中執行,提升其口腔健康品質。本結果可供臨床醫護人員參考,也建議未來將口腔照護納入抗病毒治療期間的常規中。
Background: The hepatitis C virus could cause liver cirrhosis and cancer. There is currently no vaccine for prevention. Fortunately a good antiviral treatment is available, which mainly relies on using the pegylated interferon plus ribavirin. Treatment processes often produce the discomfort symptoms of oral ulcers. When the side effects of whole body appear, patients often neglect to carry out the oral hygiene behaviors. In addition, oral hygiene is always neglected by nursing staff, which would increase oral discomfort and induce oral inflammation. It may influence patient's appetite and immunity at this time. Furthermore, patients may give up their treatment. Therefore, providing oral care is an important task for nursing professional, which could mainly reduce oral ulcers, increase oral comfort and complete treatment rate. However, the systematic review showed that using oral care program in hepatitis C patients during antiviral therapy was limited. Aims: To explore the effectiveness of oral care program for hepatitis C patients receiving antiviral treatment, including changed of the concepts of oral health, oral health behaviors and oral health status. Methods: This study was designed as one group of quasi-experimental pretest-posttest. We implemented face-to-face interviews with structured questionnaires, including demographics, oral health behaviors and oral health status. The period of oral care intervention was three months for each patient. We collected patients' oral health behaviors, oral health status and plaque index between pretest and posttest. The instruments included dental plaque indicator and oral care materials. SPSS software for windows version 22 was applied in this study. Both descriptive and inferential statistics were used, including percentage, mean, standard deviation, McNemar test and generalized estimating equation. Results: Of the total 34 participants, who met the inclusion criteria, from the outpatient clinics in southern Taiwan. The mean age was 50 (SD=11, range=21-76), women accounted for 55.9%. The finding indicated that oral care program for participants in frequency of brushing teeth (p<.001), using dental floss or interdental brushes (p<.001) and comfort in oral cavity (p<.001) were significantly improved. The generalized estimating equation showed the score of oral health had significantly improved in the first (β= -1.559, p<.001), the second (β= -2.074, p<.001) and the third month (β= -2.251, p<.001). The plaque index (PI) also indicated significantly improved in the first (β= -1.732, p<.001), the second (β= -2.120, p<.001) and the third month (β= -2.490, p<.001). Conclusions: The result of this study showed that oral care program can reduce oral discomfort, improve oral health behaviors and oral health status during patients receiving antiviral treatment. Additionally, this is a simple and low cost program, which can be performed at home easily, and could enhance their quality of oral health. This finding can provide as a reference for clinician. It is recommended that oral care should be included in the routine of antiviral treatment in the future.
誌謝 Ι
中文摘要 II
ABSTRACT III
目次 V
表目次 VII
圖目次 VIII
第一章 緒論 1
第一節 研究背景動機 1
第二節 重要性 3
第三節 研究目的 3
第二章 文獻探討 4
第一節 C型肝炎之現況 4
第二節 口腔健康行為、口腔健康狀態與口腔疾病之探討 9
第三節 抗病毒藥物治療對口腔健康的影響 11
第四節 基本口腔照護標準 12
第五節 歐倫的護理理論 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 研究假設 15
第四節 研究場所 16
第五節 名詞界定 17
第六節 研究工具及測量方法 18
第七節 研究步驟 20
第八節 資料收集過程 22
第九節 研究倫理 23
第十節 資料分析 24
第四章 研究結果 26
第一節 參與者之人口學特性、口腔健康觀念、口腔健康行為與口腔健康狀態 26
第二節 參與者接受口腔照護介入後口腔健康行為之改變 28
第三節 口腔照護介入後參與者口腔症狀頻率、口腔健康分數與牙菌斑指數於不同時間點之分布及比較 35
第五章 討論 43
第六章 結論與建議 48
第一節 研究限制 48
第二節 結論與建議 49
參考文獻 51
中文部分 51
西文部分 55
附錄 64
附錄一 專家效度信函 64
附錄二 口腔健康問卷評估表 - 專家名單 65
附錄三 專家效度問卷 66
附錄四 內容效度問卷表評分結果及建議 72
附錄五 口腔健康訪談與問卷評估表(正式問卷) 76
附錄六 人體試驗委員會同意書 79
附錄七 口腔照護指導員證書 81


表目次
表1 干擾素治療C型肝炎病毒於過去、現在與未來之方案 7
表2 複方口服直接抗病毒藥 8
表3 專家效度指標 18
表4 變項與描述/推論統計 25
表5 參與者社會人口學變項之分布情形 29
表6 口腔照護前後參與者口腔健康行為改善狀況 34
表7 口腔照護介入後參與者於不同時間點發生口腔症狀頻率分布及比較 36
表8 口腔照護介入後口腔健康分數與牙菌斑指數各時間點之分布 39
表9 口腔照護介入後口腔健康分數得分在不同時間點之比較 41
表10 口腔照護介入後牙菌斑指數在不同時間點之比較 42
表11 口腔照護介入後參與者口腔舒適改善狀況 45

圖目次
圖1 研究架構圖 14
圖2 研究步驟流程圖 21
圖3 收案流程圖 22
圖4-1 口腔健康分數於不同時間的分布比較 41
圖4-2 牙菌斑指數得分於不同時間分布比較 42


中文部分
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西文部分
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