臺灣博碩士論文加值系統

本論文目的在探討傷口照護團隊介入對糖尿病足潰瘍病人之生活品質影響。現況發現糖尿病是一個複雜性、多致病因子的疾病，常造成足部感覺、運動、循環功能與結構上的異常，故較一般人更容易產生傷口與感染的現象，嚴重者甚至須要截肢。有鑑於截肢，對於個人與家庭的影響甚鉅，故我們希望發展此一團隊的傷口照護模式，對糖尿病足潰瘍病患早期介入預防、積極治療，不論是各科整合、傷口治療、鞋具預防與衛教居家照護等，以提升病患的生活品質。本研究採單組前後測之類實驗性研究設計，於台灣北部某一區域教學醫院，經專科主治醫師診斷為糖尿病足潰瘍Gr2-5等級、接受傷口照護團隊介入措施為研究對象，總共23位個案參與本研究計畫，但實際完成研究之樣本共20人。研究工具包括基本資料問卷、加的夫傷口影響生活質量問卷。研究結果以 SPSS 電腦軟體進行分析，統計分析包括信度分析、效度分析、差異性分析。結果：本研究對象在傷口治療之成效有：傷口治療團隊介入後對於糖尿病足潰瘍在治療方法上，有更多評估及選擇，不論在手術清創、高壓氧、負壓抽吸、進階敷料使用等皆有提升，對於傷口改善有顯著助益。針對生活品質之綜合層面的結果顯示，在治療前後對於社交生活的差異中，Z值為-3.300，P值為0.001(<0.05=α)，代表社交生活有顯著差異存在。對於社交壓力的差異中，Z值為-3.521，P值為0.000(<0.05=α)，社交壓力也有顯著差異存在。身心狀態的差異中，Z值為-3.183，P值為0.001(<0.05=α)，身體症狀與日常生活的差異中，Z值為-3.743，P值為0.000(<0.05=α)，生活壓力的差異中，Z值為-3.727，P值為0.000(<0.05=α)，整體生活品質的差異中，Z值為-2.982，P值為0.003(<0.05=α)，代表身心狀態、身體症狀與日常生活、生活壓力、與整體生活品質在病患治療前與治療後有顯著差異性存在。結論：傷口治療團隊介入可以改善糖尿病足潰瘍傷口，及介入治療後確實有效提升糖尿病足潰瘍病人之生活品質。

OBJECT:The purpose of this research is to evaluate the impact of the wound-care team (WCT) on quality of life (QoL) of patients with diabetic foot.
CONTEXT:Diabetic foot is a disease with complex and multiple risk factors and resulting in not only the abnormality of sensation and motion over feet but also the poor circulation and deformity of physical structures. It may introduce severe infection over lesion site and gangrene change of low limbs. In some cases, the amputation of limbs is life-saving procedure. Compared with normal people, the quality of life in patients with limb amputation will be worse. The modern wound-care team composed of the interdisciplinary healthcare teamwork, advanced dressing material and technology, modified surgical technique, and home-based wound care. To evaluate the impact of WCT intervention in diabetic foot patients is necessary for improving the quality of healthcare.
METHODOLOGY:This study is based on quasi-experimental design. The sample comes from a regional hospital in northern region of Taiwan. All the patients is recruited after the confirmed diagnosis of diabetic foot, Wanger’s Grade 2 to 5, by the doctors with wound-care specialty. The result was analyzed via SPSS 22.0.
RESULT:There are 23 cases and these are also under the intervention of WCT. 20 of 23 cases completed the course of WCT care and were enrolled into this study. The result shows that surgical debridement, hyperbaric oxygen therapy, negative pressure wound care, and advanced dressing material improved the outcome of wound diabetic foot patients. The study in QoL also reveals the significant change in social activities before and after intervention (Z=-3.300, p=0.001(α=0.05)). The peer’s pressure also shows the significant difference (Z=-3.521, p=0.000(α=0.05)). Mental status (Z=-3.183, p=0.000(α=0.05)), physical symptoms (Z=-3.743, p=0.001(α=0.05)), burden of daily life (Z=-3.727, p=0.000(α=0.05)), general quality of life (Z=-2.982, p=0.003(α=0.05)) are unveiled in this research, too.
CONCLUSION:The intervention of WCT could improve the quality of life in patients with diabetic feet, Wanger’s Grade 2-5. It is also shows the effectiveness in wound healing under WCT care.

第一章 緒論 1
第一節 研究背景 1
第二節 研究動機 2
第三節 研究目的 2
第四節 研究範圍 3
第二章 文獻探討 4
第一節 糖尿病之介紹 4
第二節 糖尿病足潰瘍之治療 7
第三節 糖尿病足相關之生活品質 16
第四節 團隊介入之影響 19
第三章 研究方法 21
第一節 研究架構與假說 21
第二節 研究設計 23
第三節 研究步驟 24
第四節 研究分析工具 25
第四章 研究結果 28
第一節 敘述性統計 28
第二節 信度分析 33
第三節 差異性檢定 37
第四節 研究假說統整 41
第五章 結論與建議 44
第一節 研究結論 44
第二節 研究建議 45
參考文獻 47
附錄 55

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