臺灣博碩士論文加值系統

摘要

研究背景：帕金森氏症是一種複雜的神經病變疾病，臨床病症常伴隨有睡眠問題等情形，這些非運動障礙症狀會導致身心不適，進而影響健康和生活品質。其常見的睡眠困擾有失眠（入睡困難、睡眠中斷、清晨早醒）及日間嗜睡等問題。睡眠障礙可藉由藥物及輔助醫療方式（運動、針灸、中藥及穴位指壓等）獲得改善。經過去文獻指出，神門穴位按壓有助於改善睡眠品質。

研究目的：（一）探討帕金森氏症與睡眠情形、生活品質之間的關聯性 （二）探討穴位按壓對於改善睡眠障礙及生活品質的成效。

研究方法：本計畫採二階段不同的研究設計方式同時進行。第一階段，以病例-對照研究設計方式，從彰化某醫院門診選取符合篩選條件的帕金森氏症患者 80 位作為病例組，同時自社區選取無罹患帕金森氏症的住民 135 位作為對照組，並完成主觀性睡眠品質評估量表、帕金森氏症評估工具以及世界衛生組織生活品質量表等結構式問卷量表；第二階段，進一步從第一階段已篩選出符合條件的病例組 80 位，以區集隨機分配的方式，區分為實驗組及對照組，實驗組以彈性腕帶連續施予神門穴位按壓，對照組則配戴無按壓療效的彈性腕帶，持續 8 週±1 週後停止按壓，並於介入前後各完成一次主觀的睡眠問卷及帕金森氏症生活品質量表並搭配客觀的腕動計觀察病患一星期的睡眠品質狀況。

研究結果：帕金森氏症患者與白天嗜睡、睡眠品質差、失眠情形的勝算比各為3.50(95%C.I=1.47,8.33)、2.56(95%C.I=1.19,5.54)、3.41(95%C.I=1.62,7.21)。在生活品質的部分，發現帕金森氏症病患在生理範疇、心理範疇、社會範疇及環境範疇平均分數會比一般族群少 1.84 分、1.56 分、1.09 分及 1.09 分。經過了 8 週±1 週的神門穴位按壓後，其在睡眠情形方面，發現實驗組在睡眠效率的改善情形較對照組好，在其他睡眠變項及生活品質方面則無發現較顯著的改善效果。

結論：根據本研究結果可以得知，帕金森氏症患者其各項睡眠情形及生活品質較一般族群差，但其睡眠效率可經由 8 週±1 週的神門穴位按壓後獲得改善。

關鍵字：帕金森氏症、睡眠障礙、生活品質、神門穴位

Abstract

Background: Parkinson’s disease (PD) is a complex neurodegenerative disorder. The non-motor symptoms of the disease such as sleep disorders have a significant impact on patients' well-being and quality of life. The majority of patients suffer from sleep disturbances affecting their ability to fall asleep, ability to stay asleep or day-time somnolence. Sleep disorders can be treated with medication, physical therapy, acupuncture or acupressure. Studies have suggested the efficacy of acupressure therapy in sleep regulation.In particular, acupressure at the HT-7 (Shen Men) point seems to have a therapeutic effect in individuals with disorders of initiating and maintaining sleep.

Objectives: The study aims were to assess (i) the relationships between sleep disorders and quality of life among patients with PD, (ii) the efficacy of Shen Men point acupressure system to treat sleep disorders in patients with PD.

Methods: There were two stages of the study design. First, a total of 80 patients with PD and 135 healthy subjects without PD were included in a case-control study. In this case-control study, sleep disorders were evaluated by the PSQI score, ESS score and, AIS score. In addition, WHOQOL-BREF and H&Y scale were also collected. Second, a randomized clinical trial (RCT) based on 80 patients with PD affected by sleep disorders were conducted. A device known as the elastic wristband was used to improve
symptoms related to sleep disturbances in the treated group. Secondary outcomes included sleep disorders and quality of life.

Results: The odds ratios of sleep disorders based on the PSQI score, ESS score, and AIS score were 3.50(95% C.I=1.47,8.33), 2.56(95% C.I=1.19,5.54) and 3.41(95% C.I=1.62,7.21), respectively. As for the quality of life, the four WHOQOL-BREF domains for PD were 1.84, 1.56, 1.09 and 1.09 points, respectively, which were lower than the normal values.

Conclusion: The results showed that the qulity of life and the sleep quality of patients with PD were poor than normal subjects. However, it was improved by acupressure at the HT-7 (Shen Men) point for eight weeks.

Key words: Parkinson's disease, Sleep Disorders, Quality of Life, Shen Men point

目錄
表目錄......................................................................................................................... III
附錄目錄..................................................................................................................... IV
摘要............................................................................................................................... V
Abstract ...................................................................................................................... VI
第一章、 緒論 ............................................................................................................. 1
第一節 研究背景與重要性.................................................................................... 1
第二節 研究動機.................................................................................................... 2
第三節 研究目的.................................................................................................... 3
第二章、 文獻探討 ..................................................................................................... 4
第一節 帕金森氏症................................................................................................ 4
第二節 睡眠障礙.................................................................................................... 7
第三節 生活品質.................................................................................................. 10
第四節 神門穴位按壓.......................................................................................... 12
第五節 帕金森氏症與睡眠障礙及生活品質之相關性...................................... 13
第六節 穴位按壓對於改善睡眠障礙及生活品質之相關性.............................. 14
第三章、 研究材料與方法 ....................................................................................... 15
第一節 研究設計.................................................................................................. 15
第二節 研究架構.................................................................................................. 16
第三節 研究對象及篩選條件.............................................................................. 18
第四節 評估工具.................................................................................................. 20
第五節 統計分析.................................................................................................. 26
第四章、 研究結果 ................................................................................................... 27
第一節 第一階段受試者基本人口學、生活型態及慢性疾病分布情形.......... 27
第二節 帕金森氏症患者及一般族群之睡眠品質分布情形.............................. 29
第三節 帕金森氏症患者及一般族群之生活品質分布情形.............................. 31
第四節 帕金森氏症與睡眠情形之相關性分析.................................................. 32
第五節 帕金森氏症與生活品質之相關性分析.................................................. 35
第六節 第二階段受試者資料.............................................................................. 39
第七節 第二階段睡眠情形前後測...................................................................... 40
第八節 第二階段生活品質前後測...................................................................... 42
第五章、 討論 ........................................................................................................... 43
第一節 睡眠情形的相關因子.............................................................................. 43
第二節 生活品質的相關因子.............................................................................. 45
第三節 帕金森氏症與各種睡眠情形相關性之探討.......................................... 47
第四節 帕金森氏症與生活品質相關性之探討.................................................. 49
第五節 神門穴位按壓改善睡眠情形之成效...................................................... 50
第六節 神門穴位按壓改善生活情形之成效...................................................... 52
第七節 研究限制.................................................................................................. 53
第六章、 結論與建議 ............................................................................................... 54
壹 結論.................................................................................................................. 54
貳 建議.................................................................................................................. 55
參考文獻...................................................................................................................... 56
附錄.............................................................................................................................. 85

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