臺灣博碩士論文加值系統

研究背景：
髂靜脈壓迫症候群在台灣較為少見，多數人受其症狀困擾多年，常見症狀為下肢水腫，也會合併慢性靜脈不全症狀，不僅是對外觀有所影響，更造成身體功能及生活品質的改變。淋巴水腫的自我照護是非常重要，較差的遵從性容易導致合併症的發生，導致下肢水腫症狀加劇。
研究目的：
探討電話追蹤對自我管理行為、下肢體積、身體功能及生活品質的改善成效。
研究方法：
採實驗設計，以區塊隨機分派至實驗組及對照組，兩組前測皆給予相同衛教，實驗組則額外執行三次電話追蹤介入。兩組於12週後進行後測，以驗證介入措施之成效。研究工具使用台灣版世界衛生組織生活品質簡明版(WHOQOL-BREF)評估生活品質、工具性日常生活活動量表 (IADL)評估身體功能，並測量腿圍以圓周長體積估算下肢體積大小，計算各項介入措施之遵從率來評估自我管理行為。研究資料以SPSS統整計算，以平均值、標準差等描述性統計呈現，再以t檢定、相關分析、卡方檢定及多元線性迴歸進行分析。
研究結果：
共納入56名髂靜脈壓迫症候群合併下肢水腫之個案，平均分派至實驗組(N=26)及對照組(N=26)，整體平均年齡為 58.4歲，女性佔九成，近四成個案以左腳水腫表現為主。兩組基本資料上無顯著差異。自變項與依變項的相關性檢驗，生活品質量表心理範疇與年齡呈正相關(r=0.33，p=0.01)、社會範疇與水腫症狀持續時間為負相關(ρ=-0.32，p=0.02)； IADL多元線性迴歸預測變項有年齡、受治療數目；下肢體積多元線性迴歸的預測變項為獨居、BMI、ISL stage、治療項目數等四項為顯著因子。成效指標間IADL與生活品質量表總分(r=0.29，p=0.03)，顯示當身體功能越好，其生活品質越好。
研究介入後12 週，生活品質量表總分及四大範疇皆無顯著差異。身體功能評估，兩組介入後也無顯著差異(p=0.64)。整體而言，實驗前下肢體積為2790.3 cm3 (SD=927.4)，實驗介入後為2716.1 cm3 (SD= 863.4 ) ，平均下肢體積顯著減少74.2 cm3 ( t=2.33，p<0.05)，然兩組組間前測(t=-1.74，p=0.09)及後測(t=-1.04，p=0.30)皆無顯著差異。六項介入措施：穿著彈性襪、下肢塗抹乳液、下肢淋巴自我按摩、抬腿、足踝運動及股四頭肌運動，兩組遵從率無顯著差異，自我管理行為亦無差異存在。
結論:
電話追蹤及衛教措施的介入雖未對生活品質、身體功能有顯著差異，然衛教措施的介入(穿著彈性襪、乳液塗抹、淋巴按摩、抬腿、足踝運動及股四頭肌運動)對於髂靜脈壓迫合併下肢水腫患者的下肢體積大小能有顯著改善，期許未來能繼續應用於臨床照護之參考。

Iliac Vein Compression Syndrome is rare in Taiwan. Therefore, it is not easy to diagnose. Since the iliac artery compresses the iliac vein, it might cause venous hypertension. As time goes on, it turns into a chronic venous disease. Lower extremities lymphedema is the most common symptom. It could impact not only body image but also physical function and quality of life. As lymphedema is a long-term disease, self-management is necessary. This study aims to determine the effect of phone tracking on self-management, lower limb lymphedema, physical function, and quality of life among patients with Iliac Vein Compression Syndrome.

Methods: Quality of life and Physical function is assessed with WHOQOL-BREF and IADL, respectively. Health education includes wearing elastic stockings, applying lotion, lymphatic self-massage, leg raising, ankle exercise, and quadriceps exercise. The adherence rate of six interventions is estimated as self-management behavior. Lower limb volume is measured by circumference measurement. Data are analyzed through descriptive statistics, Pearson’s correlation, t-test, Chi-Squared test, and multiple regression.

Result: Among 56 patients were included in this study and divided into two groups by block randomization and follow up for three months.
The experimental group (N=26) received phone tracking and health education while others received only health education as the control group (N=26). The mean age was 58.4 years, most were female (92.9%). Lymphedema was frequently present on the left lower extremity (42.9%). The correlation between variables indicated that the duration of edema was significantly correlated with age (r=0.28, p=0.04). WHOQOL-BREF psychological domain was positively correlated with age (r=0.33, p=0.01), and the social relationships domain was negatively correlated with the duration of edema (ρ=-0.32, p=0.02). The predictors of lower limb volume multiple regression were four items, including residence, BMI, ISL stage, and the number of treatments, which were significant factors. Correlations between IADL and WHOQOL-BREF were shown(r=0.29, p=0.03). The two groups had no significant difference in demographic characteristics. After three months of intervention, there was no significant statistically interaction between the main effect of group and time on all domains of WHOQOL-BREF, IADL, volume changes, and self-management behavior of research. Nevertheless, we found significant reduction of 74.2 cm3 in the lower limb volume in all patients (t=2.33, p<0.05).

Conclusions: Although there was no significant effect on the quality of life and physical function after three months of phone tracking, the volume of the lower limb can be improved by health education methods.

致謝......................................................................... I
中文摘要.................................................................... III
英文摘要......................................................................V
目錄.........................................................................VII
圖表目次......................................................................X
圖目次 .......................................................................X
表目次 ......................................................................XI
第一章 緒論
第一節 研究動機及重要性........................................................1
第二節 研究目的...............................................................3
第三節 名詞定義...............................................................4
第二章 文獻查證
第一節 髂靜脈壓迫症候群........................................................6
第二節 下肢淋巴水腫對身體功能及生活品質影響......................................9
第三節 髂靜脈壓迫合併下肢淋巴水腫評估及照護.....................................12
第四節 自我管理行為對髂靜脈壓迫合併下肢淋巴水腫照護的影響........................16
第五節 電話介入對慢性疾病自我管理的成效........................................18
第六節 研究架構..............................................................20
第三章 研究方法
第一節 研究設計..............................................................22
第二節 研究場所及對象........................................................24
第三節 衛教手冊內容..........................................................25
第四節 電話追蹤介入..........................................................27
第五節 研究工具..............................................................28
第六節 資料收集過程..........................................................33
第七節 資料分析方法..........................................................35
第四章 研究結果
第一節 個案基本資料分析......................................................36
第二節影響下肢水腫患者生活品質、身體功能、下肢體積變化之相關因素探討..............42
第三節介入成效比較...........................................................48
第五章 討論
第一節 髂靜脈壓迫症候群個案人口學變項..........................................60
第二節 髂靜脈壓迫症候群患者的生活品質、身體功能、下肢體積及其影響因素..............63
第三節介入措施對改善研究對象下肢水腫體積、身體功能活動、生活品質及自我管理之成效探討65
第六章 結論與建議
第一節 結論..................................................................67
第二節 限制與建議............................................................68
第三節 研究應用 ..............................................................69
參考文獻
中文部份....................................................................70
英文部份....................................................................71
附錄
附錄一 衛教手冊.............................................................83
附錄二 個案基本資料問卷......................................................86
附錄三台灣簡明版世界衛生組織生活品質問卷使用授權證明............................89
附錄四台灣簡明版世界衛生組織生活品質問卷(WHOQOL-BREF)..........................90
附錄五 工具性日常生活活動量表.................................................93
附錄六 人體試驗通過證明函....................................................95
附錄七 縮寫對照表............................................................96
圖目次
圖一 研究架構...............................................................21
圖二 研究資料收集流程........................................................34
表目次
表一 研究設計................................................................23
表二 社會人口學基本資料表.....................................................38
表三 過去病史基本資料表.......................................................39
表四 個案疾病屬性 ...........................................................40
表五 基本資料與成效指標之相關性 ..............................................44
表六 成效指標間之相關性.......................................................46
表七 基本屬性與生活品質、身體功能及下肢體積之多元線性迴歸分析....................47
表八 整體生活品質總分兩組前後測比較 ...........................................50
表九 生活品質-生理健康層面兩組前後測比較.......................................51
表十 生活品質-心理層面兩組前後測比較...........................................52
表十一 生活品質-社會關係層面兩組前後測比較 ....................................53
表十二 生活品質-環境關係層面兩組前後測比較.....................................54
表十三 功能性身體功能量表總分兩組前後測比較....................................56
表十四 下肢體積兩組前後測比較.................................................57
表十五 自我管理行為兩組後測比較...............................................59

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