臺灣博碩士論文加值系統

目的
住院病人的意外事件中「跌倒」的發生率常居首位，一旦發生跌倒意外，除病人生活品質受到影響外，因跌倒造成病人延遲抗癌治療與延長住院天數，亦造成醫療社會成本負擔。有別以往文獻多針對老人或老年癌症住院病人進行跌倒危險因子探討，本研究以住院癌症病人為樣本分析造成癌症住院病人跌倒之危險因子，以有效預防住院癌症病人跌倒意外事件。

方法
採橫斷式、相關性研究設計。資料來源取自某醫學中心資料庫2015年之電子病歷，研究樣本為癌症第三期及第四期之住院病人，並以住院期間有無跌倒事件進行配對，合計332筆資料，透過卡方檢定、獨立樣本t檢定、羅吉斯迴歸分析進行實證分析。

結果
實證結果顯示造成住院癌症病人跌倒之危險因子有癌症種類、轉移、共病症、跌倒前ADL、多重用藥、疼痛、癌症相關治療。跌倒樣本中有較高之共病症數(1.16個，p < .001)及服藥數量(2.24顆，p < .001)。每增加一種共病症，跌倒風險上升2.52倍（OR = 2.52, 95% CI = 1.52-4.19, p < .001），而每多服用一種藥物，跌倒風險上升6.04倍（OR = 6.04, 95% CI = 3.45-10.59, p < .001）。

結論
實證結果可提供臨床醫護人員進行早期高風險跌倒病人篩選參考，進而對各項危險因子設計因應之防跌措施，以降低未來住院癌症病人跌倒發生率，提升住院病人生活品質

Objectives
The incidence of falls is usually in the first place among the accidents experienced by inpatients. When a fall occurred during the hospitalization, the quality of life will be affected and the delayed the regular cancer treatment as well as prolonged the hospital stay. Those consequences would increase medical and social costs and disease burdens. Previous studies usually focused on the risk factors of falls in elderly or elderly patients with cancer. This study selected inpatients with cancer as the samples to explore the risk factors of falls, in order to effectively prevent the accident of fall in inpatients with cancer.

Methods
This is a cross-sectional study using the correlation design. This study conducted the electronic medical charts from a medical center in 2015. The samples were inpatients with cancer in 3 or 4 stage. Besides, this study applied the propensity score to match the target and compared group by their falls experienced during the hospitalization, and remained 322 cases for both groups. This study used Chi-square test, independent sample t test, and logistic regression to perform those analyses.

Results
The results revealed that the risk factors of falls in inpatients with cancer included cancer type, metastasis, comorbidities, pre-fall ADL score, multiple drug use, pain, and cancer therapies. There were higher numbers of comorbidities(1.16, p < .001) and drug numbers taken(2.24, p < .001)in the samples of target group who the fall experience during the hospitalization. The risk of falls had 2.52 times higher (OR = 2.52, 95% CI = 1.52 to 4.19, p< .001) with the increased comorbidities number as well as with the drug numbers taken 6.04 times (OR = 6.04, 95% CI = 3.45 to 10.59, p < .001).

Conclusion
The study results can provide as an important reference for clinical physicians and nurses to screen patients with a higher risk of falls in an
early stage. Furthermore, they can creat feasible designs or counter
measures for preventing falls according to various risk factors, in order to reduce the incidence of falls in inpatients with cancer in the future and improve their quality of life.

目錄
中文摘要……………………………………………………….....I
英文摘要…………………………………………………………….…III
目錄………………………………………………………………….…VI
表目錄……………………………………………………………...…VIII
圖目錄……………………………………………………………….…IX
第一章 緒論……………………………………………………………1
第一節 研究背景與動機…………………………………………1
第二節 問題陳述…………………………………………………4
第三節 研究目的及研究假設……………………………………5
第四節 研究之重要性……………………………………………6
第二章 文獻探討………………………………………………………7
第一節 人口學變項與住院癌症病人跌倒之關聯性……………7
第二節 健康狀況與住院癌症病人跌倒之關聯性………………8
第三節 癌症種類與跌倒之關聯性………………………………18
第三章 研究方法………………………………………………………20
第一節 研究架構…………………………………………………20
第二節 研究設計…………………………………………………21
第三節 研究對象及研究資料來源………………………………21
第四節 變項的操作型定義………………………………………22
第五節 統計分析方法……………………………………………26
第四章 研究結果………………………………………………………28
第一節 個人背景變項及跌倒之分布狀況………………………28
第二節 個人屬性變項與跌倒發生之關聯性....…………………34
第三節 個案發生跌倒之相關危險因子…………………………40
第五章 討論與建議……………………………………………………45
第一節 研究結論…………………………………………..……..45
第二節 過去文獻比較與討論……………………………………47
第三節 本研究之優點、限制與建議……………………………51
第四節 研究結果之應用…………...…………………………….52
參考文獻………………………………………………………………..53
中文部分…………………………………………………………..53
英文部分………...………………………………………………...54

表目錄
表1 研究變項之操作型定義………………………………………23
表2 個人背景變項及跌倒之描述性統計表………………………31
表3 個人背景變項及跌倒發生之關聯性…………………………36
表4 共病症數、服藥數量、治療數量與跌倒發生之關聯性…….40
表5 與跌倒發生有關聯之羅吉斯迴歸…………………………….41
表6 與跌倒發生有關聯之羅吉斯迴歸II……………………….....43

圖目錄
圖一 住院癌症病人跌倒相關危險因子分析之研究架構圖………21

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