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研究生:陳瑜如
研究生(外文):CHEN,YUJY
論文名稱:探討大腸鏡檢查前使用一日低渣餐包對清腸品質的影響及效益
論文名稱(外文):Comparing The Effect of A 1-day Prepackaged Low-Residue Diet with the Self-Prepared Low-Residue Diet on the Quality of Bowel Cleansing for Colonoscopy
指導教授:黃聖雄黃聖雄引用關係
指導教授(外文):HUANG,SHENG-XIONG
口試委員:王雅容黃琬婷
口試委員(外文):WANG,YA-JUNGHUANG,WAN-TING
口試日期:2024-05-23
學位類別:碩士
校院名稱:大葉大學
系所名稱:護理學系碩士班
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:2024
畢業學年度:112
語文別:中文
論文頁數:60
中文關鍵詞:大腸鏡檢查低渣餐包自備低渣飲食清腸品質病歷回溯法
外文關鍵詞:colonoscopyprepackaged low-residue dietself-prepared low-residue dietbowel cleansingretrospective chart review
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世界衛生組織國際癌症研究機構(International Agency for Research on Cancer, IARC)公布2020年癌症統計數據指出,大腸癌至今已成為全世界發生前三名及死亡率第二,大腸癌在全球的發生率和死亡率持續的上升,估計2040年將對全球醫療體系和經濟產生重大的挑戰及家庭負擔。隨著飲食西化及生活習慣的改變,大腸癌快速增加中,據衛生福利部癌症登記資料指出,大腸癌在台灣是常見的癌症之一。大腸癌是少數癌症中可以用篩檢降低發生率及死亡率的癌症。然而,多數患者對於大腸鏡檢查前腸道準備的飲食較難以遵從,使得患者腸道準備不佳且檢查意願下降。近期醫療院所開始引進低渣餐包提高腸道準備的便利性,同時也增加大腸鏡檢查的品質。目前相關研究對於低渣餐包對清腸品質的效益仍未有一致之情形,低渣餐包對清腸品質的影響及效益仍需進一步檢視。
本研究採比較性研究設計,以病歷回溯法檢視大腸鏡檢查前使用一日低渣餐包對清腸品質的影響及效益。本研究樣本來源為台灣南部一所區域教學醫院,以該院於2022年11月01日至2023年11月30日,腸胃科門診安排大腸鏡檢查患者為研究對象,以分層系統隨機抽樣進行樣本選取,合計1,000位病患參與本研究。研究工具為自擬問卷,利用電子病歷資料進行蒐集,其內容包含基本人口學資料、Aronchick量表。描述性統計以人數(n)、百分比(%)、平均值(mean)與標準差(standard deviation, SD)進行分析。以獨立樣本t檢定(independent t test)、卡方檢定(Chi-squared test)分析自變項與清腸品質之相關性;並以多元羅輯斯迴歸分析探討大腸鏡檢查前使用一日低渣餐包對清腸品質的影響因素。
本研究結果發現,低渣餐包相較自備低渣飲食有較佳的腸道清潔度(χ2 = 99.29;p < 0.001)。在腸道清潔度影響因素方面,根據羅輯斯迴歸分析結果顯示,使用低渣餐包的人相較於自備低渣飲食的人,較容易有較佳的腸道準備清潔度(OR = 13.26, 95% CI [7.23, 24.32], p < 0.001)。相反地,第一次進行大腸鏡檢查的人(OR = 0.49, 95% CI [0.31, 0.78], p = 0.002)與檢出更多的息肉切除數量(OR = 0.73,95% CI [0.59, 0.89],p = 0.002),則會較不容易有良好的腸道準備清潔度。
本研究發現低渣餐包有較佳的腸道清潔度效果,雖然目前低渣餐包為檢查自費項目,建議政府單位可進行補助,降低使用低渣餐包的門檻,有助於減少患者大腸鏡檢查前飲食準備的困擾及壓力,增添便利性及飲食順從度,能夠讓檢查可以更加安全並有助於提高腸道清潔品質。

Background
Colorectal cancer (CRC) has become a prevalent cancer with a high incidence and mortality rate worldwide, and it will pose a significant challenge to the global healthcare system and economy, as well as a burden on families. However, CRC is one of the few cancers for which screening can effectively reduce both incidence and mortality rates. Colonoscopy is the gold standard for screening for CRC and a crucial diagnostic tool for colorectal disorders. Nonetheless, adequate bowel cleansing is vital for the diagnostic accuracy of CRC and results in the effective implementation of colonoscopy. To ensure successful colonoscopies, healthcare institutions have introduced low-residue diet packages to enhance the convenience of bowel preparation and improve the quality of bowel cleansing. However, research on the efficacy of low-residue diet packages for bowel cleansing remains inconclusive.
Methods
A comparative study with a retrospective chart review design was performed to examine the influence of a one-day low-residue diet package on bowel cleansing. Subjects were drawn from a regional teaching hospital in southern Taiwan with stratified systematic random sampling, including 1,000 patients scheduled for colonoscopy between November 1, 2022, and November 30, 2023. Data were collected using a self-designed questionnaire and electronic medical records, which included demographic information and the Aronchick scale. The distribution of demographic and clinical variables was analyzed using descriptive statistics, including counts, percentages, means, and standard deviations (SD). Independent t-tests and chi-squared tests examined the correlation between independent variables and bowel cleansing. The multiple logistic regression was applied to examine potential factors associated with bowel cleansing.
Results
The result of multiple logistic regression reveals that individuals using low-residue meal packs are more likely to achieve adequate bowel cleansing (OR = 13.26, 95% CI [7.23, 24.32], p < 0.001) compared to those who conducted self-prepared low-residue diet. Conversely, the first time for colonoscopy (OR = 0.49, 95% CI [0.31, 0.78], p = 0.002) and the number of polyps detected (OR = 0.73, 95% CI [0.59, 0.89], p = 0.002) were less likely to achieve good bowel cleansing quality.
Conclusions
The prepackaged low-residue diets had a significant effect on bowel preparation quality. The current study's findings suggested that government organizations would offer financial subsidies for the accessibility of prepackaged low-residue diets to better bowel cleansing. Moreover, prepackaged low-residue diets would also help patients alleviate bowel preparation difficulties and stress and ultimately contribute to safer and more successful colonoscopies.

目錄
中文摘要 I
英文摘要 III
目錄 V
圖目錄 VI
表目錄 VII
第一章 緒論
第一節 研究背景與動機 1
第二節 研究目的 4
第三節 名詞解釋 5
第二章 文獻探討 第一節 大腸直腸癌現況 11
第二節 大腸鏡檢查前清腸品質之影響因素 15
第三章 研究設計與方法
第一節 研究架構 20
第二節 研究設計 21
第三節 研究場所與研究樣本 22
第四節 研究工具 24
第五節 研究步驟 26
第六節 資料處理與分析方法 27
第七節 研究倫理考量 28
第四章 研究結果
第一節 描述性統計分析 29
第二節 清腸品質 32
第三節 基本人口學變項與清腸品質相關性分析 33
第四節 清腸品質之影響因素 36
第五章 討論
第一節 清腸品質的影響因素 38
第二節 大腸鏡次要研究指標結果 41
第三節 結論及研究限制 42
參考文獻
中文參考文獻 44
英文參考文獻 45
附錄
附件一 研究問卷 63
附件二 研究倫理委員會審核證書 64


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