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研究生: 蕭秀玲
Hsiao, Hsiu Lin
論文名稱: 腹膜透析病人生活品質及其相關因素之研究-以台北市某醫學中心腹膜透析病人為例
An investigation on the quality of life and its related factors in peritoneal dialysis patients ― using the peritoneal dialysis patients of a medical center at Taipei city as an example
指導教授: 董貞吟
Tung, Chen-Yin
學位類別: 碩士
Master
系所名稱: 健康促進與衛生教育學系
Department of Health Promotion and Health Education
論文出版年: 2016
畢業學年度: 104
語文別: 中文
論文頁數: 135
中文關鍵詞: 腹膜透析生活品質心理困擾社會支持營養狀況
英文關鍵詞: peritoneal dialysis, quality of life, psychological distress, social support, nutritional status
DOI URL: https://doi.org/10.6345/NTNU202204821
論文種類: 學術論文
相關次數: 點閱:147下載:47
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  • 本研究旨在探討腹膜透析病人生活品質及其相關因素,以台北市某醫學中心腹膜透析中心門診病人為對象,採結構式問卷為研究工具,共取得256份有效問卷,回收率77.6%,另外也收集白蛋白、血色素及蛋白質異化速率等控制資料,並以單因子變異數分析、皮爾森積差相關、多元逐步迴歸分析等進行統計分析,主要發現如下:
    一、 研究對象生活品質總分之平均得分為87.76±14.08分。生活品質各範疇中,得分最高為環境範疇,其次是社會關係範疇,再其次是生理與心理範疇。
    二、 研究對象心理困擾程度大都介於「身心適應良好」至「輕度情緒困擾」間。45.3%的研究對象沒有明顯心理困擾,困擾問題以睡眠困難為主。
    三、 研究對象有高程度的社會支持,且以來自醫護人員的社會支持度高於家人親友的社會支持度。
    四、 研究對象教育程度愈高、有工作及退休者與有一種其他慢性病的人,生活品質愈好;年紀、經濟狀況與心理困擾呈現負相關;有伴侶關係者及透析時間在5年以下者有較高的社會支持度。
    五、 研究對象心理困擾與生活品質呈現負相關;社會支持與生活品質呈現正相關;營養狀況只有白蛋白與生活品質的心理範疇有正相關及血紅素與生活品質的社會關係範疇有負相關,其餘營養指標對於生活品質均沒有達到統計上的顯著相關。
    六、 研究對象之職業、心理困擾及醫護人員社會支持對生活品質總分有顯著預測力;職業、合併症及心理困擾對生活品質生理範疇有顯著預測力。白蛋白、心理困擾與家人親友社會支持對生活品質心理範疇有顯著預測力;性別、職業、心理困擾及家人親友社會支持對生活品質社會關係範疇有顯著預測力;心理困擾及醫護人員社會支持對生活品質之環境範疇有顯著預測力。

    The purpose of this study was to investigate the quality of life (QOL) and its related factors in peritoneal dialysis (PD) patients. Structured questionnaires were used to evaluate the patients in the outpatient clinics of a PD center in Taipei City. A total of 256 valid responses were gathered with a response rate of 77.6%. Controlling factors such as serum albumin level, hemoglobin level and protein catabolic rate were collected and analyzed using univariate ANOVAs, Pearson product-moment correlations and multiple stepwise regressions. The major findings were as follows:
    1. The mean total QOL score of the study subjects was 87.76±14.08. The domain that presented the highest score was ‘Environment’, followed by the ‘Social Relationships’ domain, then the ‘Physical’ and ‘Psychological’ domains.
    2. The levels of psychological distress of the study subjects were between ‘being physically and mentally well’ and ‘having mild emotional distress’. 45.3% of the study subjects had no remarkable psychological distress, the major source of distress was sleeping difficulty.
    3. The study subjects had high levels of social support that were higher from the medical staff than from family and friends.
    4. Study subjects with higher educational levels, having a job, being retired, or having only one other chronic disease had higher QOL scores. Age and economic status showed negative correlations with psychological distress. Study subjects in a relationship or under dialysis for less than 5 years had higher social support.
    5. Psychological distress levels of the study subjects were negatively correlated with QOL. Social support was positively correlated with QOL. Serum albumin level correlated positively with the psychological domain of QOL while hemoglobin level correlated negatively with the social relationships domain of QOL. Other nutrition indicators did not have a statistically significant correlation with QOL.
    6. Occupation, psychological distress and social support from medical staff of the study subjects had a significant predictive value for the total QOL scores. Occupation, comorbidity and psychological distress had a significant predictive value for the physical domain of QOL. Serum albumin level, psychological distress and social support from family and friends had a significant predictive value for the psychological domain of QOL. Sex, occupation, psychological distress and social support from family and friends had a significant predictive value for the social relationships domain of QOL. Psychological distress and social support from medical staff had a significant predictive value for the environment domain of QOL.

    目錄 中文摘要……………………………………………………….….……Ⅰ 英文摘要…………………………………………………………..……Ⅲ 致謝…………………………………………………………………..…Ⅴ 表目錄………………………………………………………….….……Ⅸ 圖目錄………………………………………………………….….……XI 第一章 緒論 1 第一節 研究動機與重要性……………………………………….1 第二節 研究目的………………………………………………….4 第三節 研究問題………………………………………………….5 第四節 研究假設………………………………………………….6 第五節 名詞界定………………………………………………….7 第二章 文獻探討……………………………………….10 第一節 腹膜透析治療…………………………………………….10 第二節 生活品質………………………………………………….14 第三節 心理困擾………………………………………………….28 第四節 社會支持………………………………………………….33 第三章 研究方法……………………………………….37 第一節 研究設計………………………………………………….37 第二節 研究架構………………………………………………….38 第三節 研究對象………………………………………………….39 第四節 研究工具………………………………………………….40 第五節 研究步驟………………………………………………….47 第六節 資料處理與分析………………………………………….49 第四章 結果與討論………………………………………………… 51 第一節 研究對象各變項之現況分析……………………………51 第二節 研究對象生活品質、心理困擾、社會支持、營養狀況在 背景因素上之差異………………………………………69 第三節 研究對象心理困擾、社會支持、營養狀況與生活品質之 關係………………………………………………………85 第四節 研究對象生活品質之重要預測變項……………………88 第五節 討論………………………………………………………94 第五章 結論與建議………………………………………………..104 第一節 結論…………………………………………….……… 104 第二節 建議 ...…………………………………………….……106 參考文獻 109 中文部分…………………………………...……………………..109 英文部份………………………………………………...………..115 附錄 附錄一:研究調查問卷……………………………………..………… 128 附錄二:臨床實驗同意書……………………………………..……… 135 表目錄 表2-1-1 血液透析與腹膜透析之比較………………………………...12 表2-2-1 國內外透析病人生活品質研究文獻.......................................24 表3-4-1 WHOQOL-BREF台灣版世界衛生組織生活品質問卷……..43 表3-4-2 社會支持量表問卷…………………………………………...46 表3-6-1 資料處理與分析表……………………………………….......49 表4-1-1 研究對象個人背景變項分析分布情形……………………...54 表4-1-2 研究對象生活品質之分布情形……………………………...56 表4-1-3 研究對象生活品質各題分布情形…………………………...57 表4-1-4 研究對象心理困擾之分布情形……………………………...60 表4-1-5研究對象心理困擾各題分布情形……………………………61 表4-1-6研究對象社會支持的分布情形………………………………62 表4-1-7研究對象之家人、親友社會支持分布情形…………………64 表4-1-8研究對象之醫護人員社會支持分布情形……………………66 表4-1-9研究對象營養狀況分布情形…………………………………68 表4-2-1生活品質總分與背景因素之關係統計分析表………………70 表4-2-2生活品質生理範疇與背景因素之關係統計分析表…………73 表4-2-3生活品質心理範疇與背景因素之關係統計分析表…………74 表4-2-4生活品質社會關係範疇與背景因素關係統計分析表………75 表4-2-5生活品質環境範疇與背景因素關係統計分析表……………76 表4-2-6心理困擾與背景因素之關係統計分析表……………………78 表4-2-7家人、親友社會支持與背景因素之關係統計分析表………80 表4-2-8醫護人員之社會支持與背景因素之關係統計分析表………82 表4-2-9營養狀況與背景因素之關係統計分析表……………………84 表4-3-1心理困擾、社會支持、營養狀況與生活品質之相關性……87 表4-4-1生活品質生理範疇之預測變項分析表………………………89 表4-4-2生活品質心理範疇之預測變項分析表………………………90 表4-4-3生活品質社會關係範疇之預測變項分析表…………………91 表4-4-4生活品質環境範疇之預測變項分析表………………………92 表4-4-5生活品質總分之預測變項分析表……………………………93 圖目錄 圖3-2-1研究架構………………………………………………………38

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