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研究生:蔡茹佩
研究生(外文):Ju Pei Tsai
論文名稱:頭頸癌皮瓣重建術後病患的口腔狀況影響因素之探討
論文名稱(外文):Factors related to the oral health of head and neck cancer patients with flap reconstruction
指導教授:靳燕芬靳燕芬引用關係
指導教授(外文):Y. F. Chin
口試委員:蔡玉霞楊翠雲靳燕芬
口試委員(外文):Y. H. TsaiT. Y. YangY. F. Chin
口試日期:2023-07-26
學位類別:碩士
校院名稱:長庚大學
系所名稱:護理學系
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:2023
畢業學年度:111
語文別:中文
論文頁數:98
中文關鍵詞:頭頸癌皮瓣重建手術術後張口受限口腔照護行為口腔狀況
外文關鍵詞:Head and neck cancerflap reconstruction surgerypostoperativetrismusoral care behaviororal health
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我國頭頸癌患者中,較多需接受皮瓣手術重建。手術傷口範圍包含口腔,一旦口腔發生感染將影響皮瓣存活。口腔照護可有效降低口腔感染的發生,提高皮瓣的存活率。然而在皮瓣重建術後,患者可能因疼痛、口腔纖維化等因素而造成張口困難,導致口腔清潔不易。但國內、外關於頭頸癌皮瓣重建術後患者族群的口腔狀況調查的研究相當有限。本研究目的為探討頭頸癌皮瓣重建術後病患的口腔狀況影響因素,採橫斷式調查設計(cross-sectional study design),經由立意取樣的方式於北部某醫學中心之耳鼻喉科及整形外科病房,自 2021 年 8 月 15 日至 2023 年 2 月 28 日 進行收案,選定三日內即將出院之病患的口腔照護執行者作為研究對象,共收案136人。採用的研究工具包括:(一)基本屬性結構式問卷;(二)口腔照護困擾問卷;(三)口腔照護知識量表;(四)口腔照護行為檢查表; (五)頭頸癌皮瓣重建術後口腔評估表。以Spearman Correlation、 Mann Whitney U test 及 Kruskal-Wallis 檢定分析頭頸癌皮瓣重建術後病患的口腔狀況影響因素,再以複迴歸分析預測因素。研究結果顯示:口腔照護行為較好、張口度較大、性別為女性、經濟狀況較好以及年紀較輕的口腔照護執行者,其照護的病患口腔狀況較佳。五個預測因素共可解釋口腔狀況25%的變異量,其中口腔照護行為的解釋力最大,可解釋口腔狀況11.1%的變異量。本研究建議臨床護理人員對於術後口腔狀況不佳的高危險群加強口腔護理指導,未來研發適當的用具設備,輔助口腔照護的執行,進而提升頭頸癌皮瓣重建術後病患的口腔狀況。
In Taiwan, many head and neck cancer patients undergo the treatment of flap surgery for reconstruction. The surgery involves oral cavity, thus the infection of oral cavity may impede the flap survival. Appropriate oral care can prevent the occurrence of oral infections and improve the flap survival rate. However, after flap reconstruction surgery, patients may experience trismus due to factors such as pain and oral fibrosis. Thus, the oral care becomes difficult for them. There were limited researches regarding the oral health of head and neck cancer patients with flap reconstruction. This study aimed to investigate factors influencing the oral health of postoperative flap reconstruction patients. The cross-sectional study design was used. The study was conducted at otolaryngology and plastic surgery wards in a medical center of northern Taiwan from August 15, 2021 to February 28, 2023. The purposive sampling was used. A total of 136 subjects who provided oral care for postoperative flap reconstruction patients expected to be discharged within three days were recruited. The measurement tools used in this study included: (1) a demographic survey questionnaire; (2) Oral Care Distress Questionnaire; (3) Oral Care Knowledge Scale; (4) Oral Care Behavior Checklist; and (5) Oral Assessment Scale for Patients after Flap Reconstruction Surgery. Factors influencing the oral health of postoperative flap reconstruction patients were analyzed using Spearman correlation, Mann-Whitney U tests, and Kruskal-Wallis tests, followed by multiple regression analysis. The study results indicated that patients with oral care providers who exhibited better oral care behaviors, greater range of mouth opening, female gender, better economic status, and younger age had better oral health. The five predictive factors together explained 25% of the variance in oral health, with oral care behavior being the most influential, accounting for 11.1% of the variance.
Based on the study findings, nurses should provide intensive oral care education for the high risk group with poor oral conditions after surgery. Also, appropriate equipment should be developed to assist the implementation of oral care for patients with trismus, thereby improving the oral health of patients after flap reconstruction.
中文摘要…………………………………………………….…….….…. i
英文摘要…………………………………………………….…..…..…..iii
目錄…………………………………………………..………...…......….v
圖目錄…………………………………..……………...………...…....viii
表目錄…………………………………………………...…….….….….ix
第一章 緒論………………………………………………….………...…1
第一節 研究背景及重要性…………………………….…….…...…1
第二節 研究問題與研究目的………………………..……….….….3
第三節 名詞界定……………………………….................................3
第二章 文獻查證…………………………………….........................6
第一節 頭頸癌皮瓣重建手術……………….…….…..…….…..…..6
第二節 頭頸癌皮瓣重建手術後的口腔照護…….…………..…..7
一、頭頸癌皮瓣重建手術後的口腔照護………...….…….....7
二、術後口腔照護之相關調查……………............................11
三、術後口腔照護行為之評估工具……………..……..…....12
四、頭頸癌病患口腔狀況的評估工具……..……..........…...14
第三節 影響口腔狀況之相關因素…………………………..….…17
第四節 文獻總結……………………………………….…........…..21
第三章 研究方法………………………………………………..………23
第一節 研究架構……………………………………….…..............23
第二節 研究設計……………………………….……….….…...….23
第三節 研究對象………………………………………...…..……..24
第四節 研究步驟………………………………….………….…….25
第五節 研究工具……………………………….……………..……26
第六節 研究對象權益維護與倫理考量…………………….…..…30
第七節 資料收集與分析………………………….……….…….…30
第四章 研究結果………………………….…….……………….….…..32
第一節 頭頸癌皮瓣重建病患及執行口腔照護者的基本屬性…....32
第二節 執行口腔照護者的困擾情形、口腔照護知識、口腔照護執行狀況及病患的口腔狀況………………………...........................................................….......…35
第三節 頭頸癌皮瓣重建病患術後口腔狀況的影響因素……...….40
第五章 結果討論…………………….……………………….…..........…....…47
第一節 頭頸癌皮瓣重建病患及主要照顧者的基本屬性…….......47
第二節 頭頸癌皮瓣重建術後病患口腔照護後的口腔狀況……...48
第三節 口腔照護的困擾、口腔照護知識及執行狀況…...........…48
第四節 執行口腔照護後口腔狀況的影響因素……………......….…52
第六章 結論與建議………………………………...….…........…...….….….55
第一節 結論…………………………………………………....................….…55
第二節 護理應用…………………………………..…..…...............…..…….56
第三節 研究限制與建議…………………………..…..……..…............….57
參考文獻………………………………..………….…....................................59
附錄……………………………………………..………...……..….............……72
附錄一、臨床專家效度名單……………………………..............………72
附錄二、病歷查核記錄表………………………………….….…….....….73
附錄三、口腔照護基本屬性結構式問卷……………………..….……74
附錄四、口腔照護困擾問卷……………………..……………..…....…..75
附錄五、口腔照護知識量表……………………..…………..…....……..76
附錄六、口腔照護查核表……………………..……………...….…......….77
附錄七、頭頸癌皮瓣重建術後口腔評估表…………………..…...…...78
附錄八、研究倫理委員會審查通過函……………..…..….……..……79
附錄九、參與研究同意書……………..…………….………….....………81
附錄十、研究工具使用同意書………………..….…….……..……..….86
圖目錄
3-1 頭頸癌皮瓣重建術後病患口腔照護後口腔狀況影響因素之概念架
構………………………………………………….…………….…..23
4-1 頭頸癌皮瓣重建術後病患口腔狀況之標準化殘差次數分配直方
圖……………………………………………..…..…..……………..45
4-2 頭頸癌皮瓣重建術後病患口腔狀況之標準化殘差值的常態機率分
布圖…………….…………………………………..………..……...46
4-3 頭頸癌皮瓣重建術後病患口腔狀況之預測值與殘差值之散佈
圖………………………………………………….………………...46
表目錄
4-1-1.頭頸癌皮瓣重建病患基本屬性………………………………….33
4-1-2.口腔照護執行者基本屬性……………………………...………..34
4-2-1.口腔照護執行者之困擾狀況………………………….…..…..…35
4-2-2.口腔照護執行者之口腔照護知識……………………….………36
4-2-3.口腔照護執行者之口腔照護執行狀況……………...........……..38
4-2-4.頭頸癌皮瓣重建病患口腔狀況………………………………….39
4-3-1.頭頸癌皮瓣重建病患口腔狀況相關及差異分析……………….43
4-4-1.頭頸癌皮瓣重建術後病患口腔狀況複迴歸分析及共線性診斷結
果………………………………………………………..………..45
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