臺灣博碩士論文加值系統

冠狀動脈繞道術病患於術後身體症狀困擾以及對自己的活動能力缺乏信心，進而影響術後身體活動功能的進展，且有關病患在身體症狀困擾、身體活動功能及其自我效能之相關，尚未有文獻予以深入地探討，因此，本研究之目的乃探討冠狀動脈繞道手術病患於術前一日至術後三個月，其身體症狀困擾、身體活動功能及其自我效能三者間的變化及其相關性，以為病患術後之早期復原做準備。
本研究採描述性相關性之研究設計，從93年3月至94年2月，共計12個月，以立意選樣的方式，於臺中市某醫學中心之心臟外科病房選取初次接受冠狀動脈繞道術之病患，以病患基本屬性量表、身體症狀困擾量表、身體功能狀態量表與身體功能之自我效能量表分別於術前1日、術後十日內、術後1個月及術後3個月收集資料，符合收案條件者共計95人，最後完成資料收集者有65人。
研究結果發現：（1）本研究個案之平均年齡為62±11歲，總住院日數平均為15.2±5.1日，以男性病患（佔89.2％）居多。（2）病患之症狀困擾於術後十日內最高，至術後一個月已顯著改善，術後一至三個月逐步改善。（3）身體活動自我效能與身體活動功能於術後十日內最低，術後一至三個月逐步進展，至術後三個月最高，但仍較術前為低且術後三個月仍有27.6％病患之身體活動功能處於失能狀態。（4）女性、已婚有偶者、身體質量指數愈低、功能狀態分級屬第三級以上及術後十日內者，其症狀困擾愈高。（5）年紀愈大、無運動習慣、功能狀態分級愈高及術後十日內者，其身體活動自我效能愈差。（6）年紀愈大、功能狀態分級愈高及術後十日以上者，其身體活動功能愈差。（7）症狀困擾與身體活動功能間為正相關，但無顯著差異（P = .273）。（8）身體活動自我效能與身體活動功能呈正相關，並可預測身體活動功能之進展（P < .0001）。
冠狀動脈繞道術病患於術後十日內之症狀困擾最高、身體活動功能及其自我效能最低，至術後三個月仍有27.6％病患身體活動處於失能狀態，因此護理人員於術後十日內，必須教導病患術後日常活動及心臟復健運動之執行，並建議在病患出院後仍應持續督導及追蹤，以期促進術後身體功能之恢復。
關鍵字：冠狀動脈繞道術、身體症狀困擾、身體活動自我效能、身體活動功能。

Abstract
Title of Thesis: Physical Symptom Distress, Physical Activity and Self-Efficacy in Patients Underwent Coronary Artery Bypass Grafting Surgery
Most patients who underwent coronary artery bypass graft（CABG）surgery were distressed by physical symptoms and a lack of confidence in their physical activity which lead to limited progression of their physical function. Few studies have explored the relationships among physical symptom distress, physical function, and self-efficacy in physical function. The purposes of the study were to explore the changes in physical symptom distress, self-efficacy in physical function and physical function over time, and examine the relationships among the three variables from one day before surgery to three months after surgery, in order to make preparation for early recovery in patients who underwent CABG surgery.
The descriptive correlation research design was conducted from Mar. 2004 to Feb. 2005. Patients who had their first CABG surgery were selected by purposive sampling from the cardiovascular ward at a medical center in Taichung. Baseline data were measured by symptom distress scale, self-efficacy in physical function scale and physical function scale, collected one day before operation, ten days after operation, one month and three months after operation, 60 subjects were enrolled in the study.
The major findings of this study were as follows：1. Most recipients were men(89.2%), had a mean age of 62±11 years and were hospitalized for an average of 15.2±5.0days. 2. Symptom distress was significantly remarkable at ten days after operation, then was alleviated one month after operation and progressive improvement was noted at the third month. 3.Symptom distress was worse in females, those with lower BMI, those with NYHA over classⅢ, and those who were within ten days after operation.
4.Self-efficacy in physical function was worse in aging patients, those without exercise, in higher NYHA classification and was within ten days after surgery. 5. Physical function was worse in aging patients, in higher NYHA classification and was within ten days after surgery. 6.There is a positive correlation among symptom distress and physical function, but without significantly(P = .273). 7.Self-efficacy in physical function positive correlated with physical function, and also predict the ongoing change of physical function.
Symptom distress was most serious within ten days after operation in patients who received CABG, 27.6% of them suffered from functional disability three months after operation. Nurses should teach patients to carry out daily activities and do exercise of cardiac rehabilitation since ten days after operation, and continued to follow up in order to make better recovery in physical function.
Key words: coronary artery bypass grafting（CABG）surgery, physical symptom distress, self-efficacy in physical function, physical function.

致 謝…………………………………………………………………..Ⅰ
中文摘要…………………………………………………………………..Ⅲ
英文摘要………………………………………………………………….Ⅴ
目 錄………………………………………………………………….Ⅶ
圖表目次………………………………………………………………….XI
第一章 緒論……………………………………………………………1
第一節 研究動機與重要性……………………………………………2
第二節 研究目的………………………………………………………6
第三節 研究假設………………………………………………………6
第四節 名詞界定………………………………………………………7
第二章 文獻查證………………………………………………………9
第一節 冠狀動脈疾病及冠狀動脈繞道手術…………………………9
第二節 冠狀動脈繞道術後之身、心症狀困擾……………………..14
第三節 冠狀動脈繞道術後，影響病患症狀困擾之因素…………..19
第四節 冠狀動脈繞道術後病患的身體活動自我效能及其影響因素 ………………………………………………………………..21
第五節 冠狀動脈繞道術後病患的身體活動功能及影響因素……..24
第六節 身體活動自我效能與身體活動功能之相關………………..37
第七節 身體症狀困擾與身體活動自我效能之相關……………… .39
第八節 身體症狀困擾與身體活動功能之相關………………… …..40
第三章 研究方法……………………………………………… ….. 42
第一節 研究架構……………………………………………… ….. 42
第二節 研究對象與場所……………………………………… ….. 43
第三節 研究工具……………..………………………………… … 44
第四節 研究樣本數之估計…………………………………… … ..50
第五節 研究步驟……………………………………………… … ..51
第六節 資料收集與統計分析方法…………………………… …. .52
第四章 分析與結果…………………………………………………… ...55
第一節 研究對象之基本屬性與疾病特性……………………… ...55
第二節 身體症狀困擾改變情形………………………………… ...58
第三節 身體活動自我效能改變情形…………………………… ...59
第四節 身體活動功能改變情形………………………………… ...61
第五節 基本屬性、疾病特性與症狀困擾之相關……………… ...63
第六節 基本屬性、疾病特性與身體活動自我效能之相關…… ...63
第七節 基本屬性、疾病特性與身體活動功能之相關…….…… ..65
第八節 身體症狀困擾、身體活動自我效能與身體活動功能之相關…………………………………………………………..66
第五章 討論…………………………………………………………84
第一節 研究對象之基本屬性與疾病特性…………………………..84
第二節 身體症狀困擾改變情形……………………………………..86
第三節 身體活動自我效能改變情形………………………………..88
第四節 身體活動功能改變情形……………………………………..89
第五節 基本屬性、疾病特性與症狀困擾之相關…………………..90
第六節 基本屬性、疾病特性與身體活動自我效能之相關………..91
第七節 基本屬性、疾病特性與與身體活動功能之相關…………..92
第八節 身體症狀困擾、身體活動自我效能與身體活動功能之相關 ………………………………………………………………..93
第六章 結論、建議與限制…………………………………………..97
第一節 結論…………………………………………………………..97
第二節 建議與限制…………………………………………………..98
參考資料
中文部份 ……………………………………………………………..101
英文部份 ……………………………………………………………..107
附錄
附錄一 同意書……………………………………………………… ..127
附錄二 基本資料…………………………………………………… ..128
附錄二 疾病資料…………………………………………………….. 129
附錄三 同意書………………………………………………………...130
附錄四 同意書………………………………………………………..131
附錄五 身體症狀困擾量表…………………………………………..132
附錄六 同意書………………………………………………………..133
附錄七 同意書………………………………………………………..134
附錄八 身體功能狀態量表…………………………………………..135
附錄九 身體功能狀態量表專家鑑定表……………………………..136
附錄十 專家效度名單………………………………………………..137
附錄十一 專家效度鑑定……………………………………………..138
附錄十二 身體功能之自我效能量表………………………………..139
附錄十三 身體功能之自我效能專家鑑定表………………………..140

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