臺灣博碩士論文加值系統

研究背景：長期血液透析病人會產生許多的合併症，高血磷為透析病人常見的併發症之一，血磷在長期累積之下易導致繼發性的副甲狀腺功能亢進、腎性骨病變及心血管鈣化等情形，增加冠狀動脈及心肌梗塞的罹病率，增加死亡風險；臨床上使用口服磷結合劑為高血磷症最主要的治療方式之一，綜合目前國內外文獻，透析病人服用口服磷結合劑遵從率約不超過50%，在相關影響因素方面，研究指出自我效能為血液透析病人血磷控制遵從行為最重要的預測變項，因截至目前國內研究自我效能與長期血液透析病人服用口服磷結合劑遵從行為之相關文獻有限，而國內最近一篇相關性研究距今已有8年，隨著台灣醫療環境的變遷值得再進一步探究。
研究目的：本研究旨在探討自我效能對長期血液透析病人服用口服磷結合劑遵從行為之影響。
研究方法：採橫斷式相關性研究設計，以南部某區域教學醫院之血液透析室為研究場域，收案對象為接受血液透析治療至少≧3個月以上，年齡≧18歲，有使用口服磷結合劑且意識清楚能自行或以語言溝通完成問卷者，本研究採方便取樣，以SPSS 26.0版統計軟體進行描述性及推論性資料分析，總共收案148位使用口服磷結合劑之長期血液透析門診病人，並以結構式問卷，面對面訪談方式進行收案。
研究結果：148位研究對象中以男性居多，年齡最小35歲，最大86歲，平均年齡66.44歲（SD=10.13），平均透析月數62.91個月（5.2年），共病症以高血壓者最多。服用口服磷結合劑完全遵從者僅佔12%。人口學特性之性別對長期血液透析病人服用口服磷結合劑遵從行為呈顯著相關（t=-2.168，p=0.032），女性的服藥遵從行為平均得分（4.42±0.42）高於男性（4.18±0.75）。年齡呈輕度正相關（r=0.252，p= 0.002），整體而言年齡稍高者服用口服磷結合劑的遵從行為較佳。教育程度呈顯著相關（t=2.196，p=0.030），高中（職）以下平均得分（4.36±0.55）高於高中（職）以上（4.36±0.55）。自我效能呈顯著正相關（r=0.414，p=0.000），自我效能越強者，口服磷結合劑遵從行為越佳，也是最重要的預測變項，可解釋總變異量之26.2%。期望本結果能提供臨床人員作為照護之參考，有助於透析病人遵從醫師處方服用口服磷結合劑治療高血磷症時之重要依據。

Background: Long-term hemodialysis patients will have many comorbidities, hyperphosphate is one of the common complications of dialysis patients, and long-term accumulation of blood phosphate can easily lead to secondary hyperparathyroidism, renal bone lesions and cardiovascular calcification, which increases the incidence of coronary artery and myocardial infarction and increases the risk of death. In terms of related influencing factors, the study pointed out that self-efficacy is the most important predictive variable for hemodialysis patients' compliance behavior with oral phosphorus binders, because up to now, there is limited literature on self-efficacy and long-term hemodialysis patients' compliance with oral phosphate binders, and the latest correlation study in China has been 8 years ago. With the changes in Taiwan's medical environment, it is worth further exploration.
Objectives: The aim of this study was to investigate the effect of self-efficacy on oral phosphate binder adherence in long-term hemodialysis patients.
Methods: A cross-sectional correlation study design was adopted, taking the hemodialysis room of a regional teaching hospital in southern China as the research field, and the subjects were those who had received hemodialysis treatment for ≧at least 3 months, aged ≧ 18 years old, who had used oral phosphate binders and were aware of the ability to complete the questionnaire on their own or verbal communication, and this study was convenient for sampling, and SPSS version 26.0 statistical software was used for descriptive and inferential data analysis, and a total of 148 long-term hemodialysis outpatients using oral phosphate binders were accepted. The case was accepted by means of structured questionnaires and face-to-face interviews.
Results: Among the 148 study subjects, the majority were males, with the youngest being 35 years old, the oldest being 86 years old, the average age being 66.44 years (SD=10.13), and the average number of dialysis months (5.2 years) being 62.91 months (5.2 years). Only 12% of those who took oral phosphate binders were in full compliance. Gender with demographic characteristics was significantly correlated with oral phosphate binder adherence in long-term hemodialysis patients (t=-2.168, P=0.032), and the average score of medication adherence in women (4.42±0.42) was higher than that in men (4.18±0.75). There was a mild positive correlation with age (r=0.252, p=0.002), and overall, older age patients had better compliance with oral phosphate binders. There was a significant correlation in educational attainment (t=2.196, p=0.030), and the average score below high school (4.36±0.55) was higher than that above high school (4.36±0.55). There was a significant positive correlation with self-efficacy (r=0.414, P=0.000), and the stronger the self-efficacy, the better the oral phosphate binder compliance behavior, and the most important predictive variable, which could explain 26.2% of the total variability. It is expected that this result can provide a reference for clinical staff to use as a reference for the treatment of hyperphosphatemia in dialysis patients.

摘要 I
誌謝 V
目錄 VI
第一章 緒論 1
第一節 研究動機與重要性 1
第二節 研究目的 2
第三節 研究問題 2
第四節 名詞解釋 2
第二章 文獻探討 4
第一節 長期血液透析病人之高血磷及其相關影響 4
第二節 長期血液透析病人高血磷控制方式 4
第三節 長期血液透析病人服用口服磷結合劑之遵從現況 5
第四節 長期血液透析病人服用口服磷結合劑遵從行為之相關影響因素 5
第三章 研究方法 15
第一節 研究設計 15
第二節 研究對象、場域 15
第三節 研究工具 15
第四節 資料收集過程 16
第五節 倫理考量 16
第六節 資料分析 17
第四章 研究結果 20
第一節 長期血液透析病人之人口學特性與疾病特性 20
第二節 長期血液透析病人服用口服磷結合劑遵從行為之情形 23
第三節 長期血液透析病人服用口服磷結合劑自我效能之情形 24
第四節 人口學特性與服用口服磷結合劑遵從行為關係之分析 25
第五節 口服磷結合劑副作用(便祕)與服用口服磷結合劑遵從行為關係之分析 25
第六節 長期血液透析病人之自我效能與服用口服磷結合劑遵從行為之關係 27
第七節 在控制人口學變項與副作用變項後，長期血液透析病人之自我效能對服用口服磷結合劑遵從行為預測力分析 27
第五章 討論 28
第一節 長期血液透析病人之人口學特性與疾病特性 28
第二節 長期血液透析病人服用口服磷結合劑遵從行為之現況 29
第三節 長期血液透析病人服用口服磷結合劑自我效能之現況 29
第四節 長期血液透析病人之人口學特性與服用口服磷結合劑遵從行為之探討 30
第五節 長期血液透析病人之口服磷結合劑副作用(便祕)與服用口服磷結合劑遵從行為之探討 31
第六節 長期血液透析病人之自我效能與服用口服磷結合劑遵從行為之探討及其預測力 32
第六章 結論與建議 33
第一節 結論 33
第二節 限制 33
第三節 護理應用 34
參考文獻 35
附錄一 基本資料表 39
附錄二 口服磷結合劑之自我效能量表 40
附錄三 口服磷結合劑遵從行為量表 41
附錄四 量表作者授權同意書 42

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