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系統識別號 U0007-1704200715033201
論文名稱(中文) 術後頭頸部癌症病人之症狀群集現象
論文名稱(英文) Symptom Clusters in Post-operative Patients with Head and Neck Cancer
校院名稱 臺北醫學大學
系所名稱(中) 護理學研究所
系所名稱(英) Graduate Institute of Nursing
學年度 94
學期 2
出版年 95
研究生(中文) 江淑華
研究生(英文) Su-Hua Chiang
學號 G455092003
學位類別 碩士
語文別 中文
口試日期
論文頁數 143頁
口試委員 指導教授-林佳靜
中文關鍵字 頭頸部癌症、症狀困擾、症狀群集 
英文關鍵字 Head and Neck Cancer, Symptom Distress, Symptom Clusters 
學科別分類
中文摘要 論文摘要 疾病症狀會干擾病患的生活功能,影響病患對於治療的需求與意願,症狀的重要性不只是干擾病人生活品質,也可以是疾病狀態、感染或治療的指標,或是提供疾病癒後的成效及存活率的預測(Hickok et al., 2005)。頭頸部癌症病人接受放射線治療導致的疼痛、口乾、睡眠障礙等相關的研究已有相當的數量,但是,較少針對放射線治療過程中症狀困擾嚴重度、症狀數及群集現象之探討,而腫瘤病人有極高的比例出現症狀群集現象。本研究之目的在於探討頭頸部癌症病人術後接受放射線治療第一至第六週其症狀困擾程度之改變情形為何?頭頸部癌症病患接受放射線治療後第一至第六週放射線累積劑量與症狀困擾的相關性為何?頭頸部癌症病患接受放射線治療後第一至第六週症狀群集現象為何?採縱貫性研究設計,研究工具為台灣版安德森症狀量表(MDASI-T),以方便取樣於北市某教學醫院進行收案,共有100位頭頸部癌症病患。以描述性統計、皮爾森相關、回歸分析、因素分析、群集分析及廣義線性模式(G.E.E)進行資料分析。結果發現治療前的症狀困擾為心裡難過、鬱悶,治療過程口乾、疼痛、睡眠混亂及沒胃口成為頭頸部癌症患者最主要的症狀困擾項目。症狀數與症狀困擾之間,以及症狀數與生活干擾總分間皆具有顯著相關,症狀數平均數為10.50。在放射線治療累積劑量上與症狀困擾總分具有統計上的意義,在放射線治療累積劑量中,累積劑量增加,則症狀困擾總分相對提高。在放射治療第一至第六週過程中噁心、呼吸急促、健忘、嘔吐、麻木感等症狀形成一個群集,而以疼痛、疲勞、睡眠混亂、鬱悶、胃口差、思睡、口乾、心裡難過等十一個癌症症狀形成另一群集。 癌症病人因為疾病本身或是治療過程常導致病人出現複雜的症狀困擾,而癌症症狀多變且成群集出現,藉著症狀群集的概念適時的提供介入措施,可以有效的緩解疾病症狀,改善病人疾病預後。
英文摘要 Abstract Symptoms may affect the function and quality of life of cancer patients and affect the patient’s compliance to cancer treatment. It’s commonly acknowledged for patients experienced pain、dry mouth、sleep disturbance during radiotherapy, but lack of knowledge about the symptom distress severity、symptom numbers and symptom cluster. A symptoms was highly prevalent across tumor types, the purpose of this study is to analysize the symptom cluster in operation head and neck cancer patients who receive radiotherapy from the first to sixth week by using a Longitudinal design study and the M.D.Anderson Symptom Inventory-Taiwan Form (MDASI-T). There are one hundred head and neck cancer patient at a medical center in Taipei were enrolled in this study. Data were analyzed using descriptive statistics, pearson’s correlation, regression analysis, factor analysis, Hierachical cluster analysis, and GEE (Gereralized Estimating Equation). Results revealed that the main symptom clusters in head and neck cancer patients during radiotherapy are sad, distress, dry mouth, pain, sleep disturbance and loss of appetite. There are correlation among the symptoms. There are correlation between numbers of symptom and symptom distress as well as numbers of symptom and symptom interference of daily life. The least numbers of symptom ranged from 5 to 13, with an average of 10.50. There is a significant relationship between radiation accumulative doses. During the first to sixth week of radiation therapy, there are two group of clusters, firstly include nausea, dyspnea, remembering, vomiting and numbness or tingling; secondly include pain, fatigue, disturbed sleep, distress, lack of appetite, drowsy, dry mouth and sad. Results from this study have provided important implications for clinical practice and future research.
論文目次 目 錄 頁數 致謝----------------------------------------------- I 中文摘要------------------------------------------- III 英文摘要------------------------------------------- V 目錄----------------------------------------------- VII 圖表目次------------------------------------------- X 第一章 緒論 第一節 研究動機---------------------------------- 1 第二節 研究重要性-------------------------------- 3 第三節 研究目的---------------------------------- 5 第二章 文獻查證 第一節 頭頸部癌症-------------------------------- 6 第二節 頭頸部腫瘤放射線治療---------------------- 9 第三節 癌症症狀困擾----------------------------- 13 第四節 症狀群集--------------------------------- 18 第三章 研究架構 第一節 研究架構--------------------------------- 21 第二節 研究問題--------------------------------- 23 第三節 解釋名詞--------------------------------- 24 第四章 研究方法 第一節 研究設計--------------------------------- 25 第二節 研究場所及對象--------------------------- 26 第三節 研究工具--------------------------------- 27 第四節 研究過程--------------------------------- 30 第五節 資料分析--------------------------------- 33 第五章 分析與結果 第一節 頭頸部癌症病患之人口學特徵--------------- 35 第二節 頭頸部癌症病患接受放射線治療第一至第六週其症 狀困擾程度變化--------------------------- 40 第三節 放射線治療、症狀困擾及症狀對生活干擾程度之相 關--------------------------------------- 54 第四節 頭頸部癌症病患接受放射線治療第一至第六週之症 狀群集現象------------------------------- 64 第六章 討論 第一節 頭頸部癌症病患接受放射線治療第一至第六週其症 狀困擾程度及症狀對病患日常生活之影響程度之改 變情形-----------------------------------115 第二節 頭頸部癌症病患接受放射線治療第一至第六週放射 線累積劑量與症狀困擾之相關性-------------120 第三節 頭頸部癌症病患接受放射線治療第一至第六週之症 狀群集現象-------------------------------123 第七章 結論與建議 第一節 結論-------------------------------------126 第二節 研究限制---------------------------------130 第三節 建議-------------------------------------131 參考資料 中文部份-----------------------------------------133 英文部份-----------------------------------------136 附錄 附錄一 研究同意書-------------------------------142 附錄二 個案及疾病基本資料-----------------------143 附錄三 台灣版安德森症狀量表---------------------144
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