臺灣博碩士論文加值系統

二尖瓣脫垂是心臟科中相當常見的疾病，國外盛行率為5-15％，好發於年輕女性，症狀的不適長期的困擾著病人，除了使用藥物治療來緩解其症狀外，許多研究皆提出規律運動有助於二尖瓣脫垂症狀困擾之改善，但有關運動自我效能及運動耐力分析的探討著墨較少，因此本研究目的在探討規律運動訓練對二尖瓣脫垂女性患者運動自我效能、運動耐力及症狀困擾之影響。本研究於北部某醫學中心收案，採前後測實驗法，以隨機抽籤方式分組，以 35位接受門診追蹤治療之二尖瓣脫垂女性病患爲對象，分為運動組17人，對照組18人。運動訓練為期12週、每週三次、每次三十分鐘，兩組於運動訓練計畫第一週及第十二週收集相關資料，包括運動跑步機測試運動耐力及填寫問卷，問卷包括運動自我效能量表、僧帽瓣脫垂症狀量表。並以Mann-Whitney U test、Spearman Correlation、Generalized estimating equation、Intention-To-Treat Analyses等檢定法分析資料。結果顯示：未實施運動訓練計畫前，所有個案之運動自我效能平均分數偏低，為34.6 ± 25.6分（總分120分）；運動耐力偏低為8.7 ± 1.9分；症狀困擾平均得分為20.0 ± 8.3分（總分55分）。運動訓練計畫前，所有個案運動自我效能、運動耐力與症狀困擾皆未有顯著相關。運動組運動自我效能相對於對照組明顯增加27.5分（p = .01）；運動組運動耐力於規律運動訓練後由9.4 ± 2.3 METs提升為12.8 ± 2.6 METs，經運動訓練計畫後運動組較對照組增加3.0 METs（p＜ .001）；症狀困擾方面，雖然運動組與對照組的比較，在統計上未有顯著差異（p = .05），但就運動組於運動訓練後，其症狀困擾由19.4 ± 8.3分降為10.5 ± 8.3分，可發現二尖瓣脫垂女性患者經運動訓練後，症狀困擾有緩解的趨勢。因此建議醫護人員協助二尖瓣脫垂女性患者養成規律運動的習慣，以每週三次、每次三十分鐘，運動強度為60-80 %最大運動心率之運動模式為原則，來協助提升患者之運動自我效能、運動耐力及症狀困擾的緩解。

Mitral valve prolapse is very common in cardiac disease, several abroad studies report prevalence rate that range from 5 to15%. It is likely to occur in young women. The symptoms distress for the patients is a long-term problem. In addition to use of medication to relieve their symptoms, many studies indicate that regular exercise could improve the distress of mitral valve prolapse symptoms. However, the exercise self-efficacy and exercise tolerance was rarely discussed. The purpose of this study is to investigate the effect of exercise training in patients with mitral valve prolapse in female exercise self-efficacy, exercise tolerance and symptom distress . The study was designed with pre-test and post-test experimental, randomized assignment in northern part of a medical center. The study included 35 female patients with mitral valve prolapse. 17 subjects were in exercise group, and the other 18 in control group. The exercise training included 30-minute session for each time, three times per week, lasting for 12 weeks. The relative data were collected on the baseline and last week, that is the twelveth week, including treadmill exercise testing and questionnaires. The questionnaire included exercise self-efficacy scale and mitral valve prolapse symptoms scale. The statistics are analysized with the Mann-Whitney U test, Spearman Correlation, Generalized estimating equation and Intention-to-treat analysis . The results shows that before the exercise training program, the scores in different categories of all cases were somewhat low: self- efficacy scores for 34.6 ± 25.6 points (total scores 120 points); exercise capacity for 8.7 ± 1.9 METs; symptom distress and the average for 20.0 ± 8.3 points (total scores 55 points). No significant relationships among exercise self-efficacy, exercise tolerance and symptom distress was observed. Exercise self-efficacy in exercise group significantly increased 27.5 points (p = .01) compared with the control group. After exercise training, exercise tolerance in exercise group increased from 9.4 ± 2.3 METs to 12.8 ± 2.6 METs. Exercise group was significantly improved compared to the control group, the exercise tolerance increased 3.0 METs (p <.001). Although symptom distress in the exercise group compared with the control group revealed no significant overall improvement (p = .05), the score of exercise group symptom distress decreased from 19.4 ± 8.3 points to 10.5 ± 7.0 points. Result of this study suggests that health care workers may help patients develop the habit of regular exercise, which means three times a week, thirty minutes for each time, at intensity of 60-80% maximum heart rate . According to the principles mentioned above, it could enhanced exercise self-efficacy, exercise tolerance, and possibly symptom distress relieve in female patients with mitral valve prolapse.

目錄
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
第一節 研究動機與重要性………………………………1
第二節 研究目的……….……………………………….6
第三節 名詞解釋……………………………………… 7
第二章 文獻查證
第一節 二尖瓣脫垂病患及其症狀困擾………………10
第二節 症狀困擾對於二尖瓣脫垂患者的影響………23
第三節 二尖瓣脫垂患者運動耐力之情形……………25
第四節 運動自我效能對於規律運動訓練的影響……26
第五節 規律運動訓練對二尖瓣脫垂患者症狀困擾之成
效………………………………………………33
第三章 研究方法
第一節 研究架構………………………………………37
第二節 研究設計………………………………………39
第三節 研究對象與收案場所…………………………40
第四節 研究工具………………………………………42
第五節 運動測試………………………………………46
第六節 運動訓練計畫…………………………………48
第七節 資料收集過程…………………………………51
第八節 資料統計分析…………………………………53
第四章 分析與結果
第一節 二尖瓣脫垂女性患者人口學特性……………55
第二節 年齡及教育程度與運動自我效能、運動耐力及
症狀困擾之關係……………………………62
第三節 運動自我效能、運動耐力及症狀困擾之情形64
第四節 運動自我效能、運動耐力及症狀困擾之相關性
……………………………71
第五節 規律運動訓練之介入對於運動自我效能、運動
耐力及症狀困擾之成效………………………73
第五章 討論
第一節 二尖瓣脫垂女性患者人口學特性……………83
第二節 運動自我效能、運動耐力及症狀困擾之情形85
第三節 運動自我效能、運動耐力及症狀困擾之相關性
………………………………………………88
第四節 運動自我效能、運動耐力及症狀困擾之成效…
………………………………………………89
第六章 結論與討論
第一節 結論……………………………………………92
第二節 研究限制………………………………………94
第三節 建議……………………………………………95
參考資料
中文部分 …………………………………………………97
英文部分 ……………………………………………… 100
附錄
附錄一 個案基本資料……………………………… 106
附錄二 僧帽瓣脫垂症狀測量表(MVP Syndrome Check
List, MVPSCL) …………………………………… 107
附錄三 僧帽瓣脫垂症狀測量表原著作者同意書… 108
附錄四 運動自我效能量表………………………… 109
附錄五 運動自我效能量表原著作者同意書……… 111
附錄六 運動自我效能量表專家效度名單………… 112
附錄七 Modified Bruce Protocol ……………… 113

附錄八 Borg’s自覺費力量表（Relaing of
Perceived Exertion，RPE）……………………………114
圖表目次
圖一 研究架構圖…………………………………………………38
圖二 資料收集過程………………………………………………52
圖三 二尖瓣脫垂女性患者收案流程圖…………………………58
表一 統計分析方法………………………………………………54
表二 完成計劃者與退出計劃者人口學特性之檢定……………57
表三 二尖瓣脫垂女性患者人口學特性及兩組人口學特性之檢
定……………………………………………………………61
表四 年齡及教育程度與運動自我效能、運動耐力及症狀困擾之
關係…………………………………………………………63
表五 運動訓練計畫前，二尖瓣脫垂女性患者運動自我效能之情
形，及兩組之運動自我效能得分之檢定…………………66
表六 運動訓練計畫前，二尖瓣脫垂女性患者症狀困擾之情形，
及兩組症狀困擾得分之檢定………………………………70
表七 運動自我效能、運動耐力及症狀困擾之相關性…………72
表八 兩組運動自我效能得分前後測之差異……………………74
表九 兩組運動耐力前後測之差異………………………………76
表十 兩組症狀困擾之前後測差異………………………………78
表十一 ITT分析後，兩組運動自我效能之前後測差異………… 80
表十二 ITT分析後，兩組運動耐力之前後測差異……………… 81
表十三 ITT分析後，兩組症狀困擾之前後測差異……………… 82

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