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系統識別號 U0007-1704200715050340
論文名稱(中文) 頭頸部癌患進食及營養狀況之探討
論文名稱(英文) Eating and Nutrition States in Patients With Head and Neck Cancers
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) 方慧芬
研究生(英文) Huei-Feng Fang
學號 G455091006
學位類別 碩士
語文別 中文
口試日期
論文頁數 105頁
口試委員 指導教授-賴裕和
中文關鍵字 頭頸部癌症  迷你營養評估  進食困難程度評估 
英文關鍵字 LEDS  KPS  MNA 
學科別分類
中文摘要 頭頸部癌症可施行手術、放射線及化學治療,療程中可單獨或合併進行治療方式(徐,2001;Alison et al., 2002)。多種治療的副作用中,又以口腔黏膜改變最為困擾,對病人的生理、心理、社會都會造成莫大的影響(Alison, 2002)。國內口腔癌病人以40~60歲之間最多,但30~39歲發病個案也逐年上升(林,2002);此類病人以青壯年最具生產力的人口居多,病人從診斷的衝擊、經歷切片手術及進一步放射線照射或化學治療,往往造成病人身心極大的衝擊;且若在此時罹癌對社會、家庭都會造成莫大的衝擊及影響(林,2002)。為能確實瞭解頭頸部癌症病人的營養狀況與實際飲食攝取情形及影響進食、吞嚥的相關因素或機能改變的因素探討,故本橫斷式研究旨在探討台北某醫學中心整形外科病房、口腔外科病房、耳鼻喉科病房、血液腫瘤科病房或門診頭頸部癌症病人的進食困難與營養狀況之相關問題。共收集100位個案,資料內容包括病人基本資料、進食困難程度評估、身體質量指數(body mass index; BMI)、身體功能狀態(Karnofsky’s performance status; KPS)及迷你營養評估(Mini-Nutritional Assessment; MNA)、生化值(血清白蛋白及血紅素)。資料分析以描述性統計、單因子變異數分析(one way ANOVA)、皮爾森相關(Pearson’s correlation)、逐步回歸(stepwise regression)。研究結果發現:(一)研究對象進食困難程度落在輕度或中度影響吃或吞東西。且有85%的病人顯示他們在過去的三個月因食慾、咀嚼及吞嚥困難以致影響進食量。(二)在MNA總分方面(0~30分),本研究對象平均值為17.7±4.00;超過50%的個案,依照其營養程度分類上,潛在營養不良者(MNA17~23.5)佔53%為最高,營養不良者(MNA<17)佔5%。(三)MNA總分愈低,進食困難程度得分愈高,營養狀況愈差。但無法把食物咬爛、上下顎牙齒無法咬合、吃東西時容易嗆到、食物無法吞嚥、口腔內有疤痕吃東西困難、聞不出食物味道,這六項進食困難程度為最高,且與MNA營養不良指標總分有顯著的相關性。(四)進食困難程度、BMI、KPS、血清白蛋白值、血紅素值、治療方式、合併其他慢性病及住院與否,均達統計上相關,能有效預測以MNA總分作為評估的營養狀況(R?=52.3%)。本研究結果提出改善頭頸部癌症病人進食困難的需求與其營養狀況是一個急迫但長遠的議題。期許建立臺灣頭頸部癌症病人進食與吞嚥困難及營養評估之相關資料,透過問題解決及相關因素之探討,來改善頭頸部癌症病人因疾病、治療所引發的各種需求或症狀護理及營養狀況,進而提昇頭頸部癌症病人的生活品質與尊嚴;更期待跨科部的參予,讓頭頸部癌症病人能得到更完善之醫療品質的照護。
英文摘要 The purposes of the cross-sectional study were to delineate the nutritional status and the real food intake and identify the factors influencing food intake and swallowing abilities in head and neck cancer patients. Patients were recruited from a medical center in Taipei. One hundred head and neck cancers were recruited. We assessed information related to patients’ background characters, degrees of eating difficulties, body mass index (BMI), performance status (measured by Karnofsky’s performance status, KPS), nutritional status (measured by mini-nutritional assessment, MNA), and biochemical profiles (serum albumin and hemoglobin). Data were analyzed by descriptive statistics, one way ANOVA, Pearson's regression, and stepwise regression. Several important results were found. First, most patients with eating difficulties had mild to moderate eating or swallowing disabilities. Second, majority of patients were in “at risk of malnourished” status (17.7±4.00) and 5% of patients were malnourished. Third, the 6 most stressful eating problems were: (1) not being able to completely chew up the food, (2) unfitting of upper and lower jaws during chewing, (3) easy to choke while eating, (4) not able to swallow, (5) scars in the mouth cavity, and (6) loss of smelling sense. Patients who had severer level of the above mentioned problems had more severe malnutrition status. Fourth, higher degree of eating difficulty and lower BMI, KPS, serum albumin, hemoglobin can significantly predict the level of malnutrition (R2=52.3%). The results strongly suggest the importance of improving patients eating and swallowing problems in head and neck cancer patients to further enhance patients’ nutrition status.
論文目次 目  錄 頁 數 致  謝 …………………………………………………………  Ⅰ 中文摘要 …………………………………………………………  Ⅲ 英文摘要 …………………………………………………………  Ⅴ 目  錄 …………………………………………………………  Ⅶ 附  錄 …………………………………………………………  Ⅸ 圖表目次 …………………………………………………………  Ⅹ 第一章 緒論   第一節 前言………………………………………………… 1   第二節 名詞解釋……………………………………………  4   第三節 研究目的……………………………………………  5 第二章 文獻查證   第一節 頭頸部癌症及其治療………………………………  7   第二節 營養概念……………………………………………  9 第三節 進食與吞嚥…………………………………………  14 第四節 影響頭頸部癌症病人進食與吞嚥困難之因素…… 17 第五節 頭頸部癌症病人營養狀況及影響因素 ……………   19 第三章 研究架構   第一節 研究架構……………………………………………  23 第二節 研究假設………………………………………………  25 第四章 研究方法 第一節 研究方法、對象及資料收集………………………  26 第二節 研究工具……………………………………………  28 第三節 資料收集及過程紀錄………………………………  31 第四節 資料統計與分析……………………………………  32 第五節 保障研究標本權益及隱私權之措施………………  34 第五章 分析與結果 第一節 頭頸部癌症病人之人口學特性與疾病相關資料…  36 第二節 頭頸部癌症病人之營養評估狀況…………………  40 第三節 頭頸部癌症病人進食狀況…………………………  45 第四節 頭頸部癌症病人進食困難程度 與MNA總分之相 關……………………………………………………  50 第五節 MNA營養評估指數之相關因素與預測因素………  52 第六章 討論 第一節 頭頸部癌症病人營養評估狀況………………… 56 第二節 頭頸部癌症病人進食困難程度 影響進食狀況  60 第三節 頭頸部癌症病人進食困難程度 與MNA總分之 相關…………………………………………………  62 第四節 辨識MNA營養評估指數之預測因子……………  64 第七章 結論與建議 第一節 結論………………………………………………… 66 第二節 護理上的運用………………………………………  68 第三節 研究限制與建議……………………………………  71 參考資料 中文部份……………………………………………………  73 英文部份……………………………………………………  77 附錄 附錄一 基本資料……………………………………………  90   附錄二 迷你營養評估記錄單………………………………  92   附錄三 進食困難程度評估量表……………………………  93   附錄四 研究同意書…………………………………………  94   附錄五 專家信效度問卷……………………………………  95   附錄六 收案醫院公文……………………………………… 101  圖表目次 圖一 概念架構圖………………………………………………  24 表一 進食與吞嚥動作的七階段分析………………………… 16 表二 本研究問題運用之統計方法…………………………… 33 表三 人口學特質………………………………………………  37 表四 疾病診斷及治療特徵資料……………………………… 39 表五 營養評估分析一覽表…………………………………… 42 表六 進食困難程度量表(LEDS)分析…………………… 46 表七之一 進食困難程度與疾病診斷及住院天數之關係………… 48 表七之二 進食困難程度與治療特徵之關係……………………… 48 表八 進食困難程度與腫瘤分期的關係……………………… 49 表九 LEDS與MNA與住院、門診病人的分析 …………… 49 表十 進食困難程度(LEDS)與MNA總分之相關….. …… 51 表十一 進食困難症狀嚴重程度與營養評估及身體活動狀態相     關性分析………………………………………………… 54 表十二 營養評估之逐步迴歸檢定……………………………… 54 表十三 營養評估與腫瘤分期的關係…………………………… 54
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