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系統識別號 U0026-1908201720361400
論文名稱(中文) 運用楔型枕抬高床頭改善食道癌病患於食道切除術後夜間逆流症狀成效之探討
論文名稱(英文) The effect of elevating head of bed for patients with esophageal cancer suffered from nocturnal reflux symptom after esophagectomy and reconstruction
校院名稱 成功大學
系所名稱(中) 護理學系
系所名稱(英) Department of Nursing
學年度 105
學期 2
出版年 106
研究生(中文) 黃慧珍
研究生(英文) Hui-Chen Huang
學號 T26034016
學位類別 碩士
語文別 中文
論文頁數 88頁
口試委員 口試委員-曾堯麟
口試委員-張瑩如
指導教授-方素瓔
中文關鍵字 食道癌手術  逆流症狀  睡眠品質  食道黏膜損傷程度  楔型枕 
英文關鍵字 esophageal cancer surgery  reflux symptoms  sleep quality  the degree of mucosal damage in esophagus  wedge form pillow 
學科別分類
中文摘要 研究背景:食道癌術後逆流症狀高達80%,可能持續多年或症狀加劇,且於夜間特別嚴重。夜間睡覺時採取抬高床頭的方式,利用重力的原理以加速酸液廓清的速度已證實對於胃食道逆流疾病有改善的成效,進而降低食道曝露在酸性環境的時間。然而抬高床頭措施是否能有效改善食道癌術後逆流症狀及實務面執行情形的文獻較缺乏。
研究目的:了解居家使用楔型枕抬高床頭對食道切除術後發生夜間逆流症狀病人,三個月內自述逆流症狀、睡眠品質、食道黏膜損傷改善之成效。
研究方法:本研究採交叉試驗性研究設計,以一週作為介入交換時間,兩星期後採同一種介入措施,採縱貫式的追蹤方式,檢視給予措施後不同時間點,包括14天內、一個月、二個月及三個月前後的差異。由食道癌資料庫篩選出符合條件的受試者,針對需服用藥物的個案以塊狀排列隨機分派方式為兩組。資料的收集,包括自述逆流症狀、睡眠品質及內視鏡食道黏膜變化等指標評量。收集的資料採描述性統計、線性混合模式及百分比進行統計結果分析。研究場域為南部某醫學中心。
結果:本研究收案共得14位個案,研究結果指出,藥物合併楔型枕比單純藥物使用14天內對於逆流症狀的平均分數可以達到下降的趨勢,但加上測量時間及控制變項後,無法呈現統計學上顯著改善的成效。進一步探討藥物合併楔型枕對於逆流症狀長期改善的成效,結果顯示藥物合併楔型枕在一個月、二個月及三個月的逆流分數都是下降,且都有達到統計學上顯著差異,逆流分數下降幅度以第二個月最大。但在睡眠品質方面無論是一個月、二個月、三個月雖有平均總分的下降,然未達統計學上的顯著差異,下降幅度以第一個月最多。內視鏡食道黏膜損傷方面,11位(84.6%)獲得持平以上的改善,有2位(16.7%)給予措施後變得更加嚴重。14位病患皆對楔型枕的使用感到滿意。
結論與臨床建議:單純藥物使用或是藥物合併楔型枕使用對於逆流症狀都有改善的成效,然對睡眠品質改善的成效有限。未來除了追蹤食道癌疾病復發與否,應重視病人有無逆流症狀,並配合內視鏡檢查確認有無逆流性食道炎,給予適當的藥物治療及正確的衛教,包括配合生活型態的改變及飲食衛教。另可藉由產學合作模式,依照個案身形設計符合人體工學的楔型枕,以降低夜間睡眠時逆流症狀的發生,提高生活品質。
英文摘要 Background: Patients with esophageal cancer suffered from nocturnal reflux symptom after esophagectomy and reconstruction. It has been demonstrated that nocturnal bed head elevation improves the symptoms of gastro-esophageal reflux (GE reflux) by facilitating the clearance rate of digestion fluid with gravity. However, no study examines the effect of nocturnal bed head elevation on patients with esophageal cancer undergoing esophagectomy and reconstruction.
Purpose: To examine the effect of elevating head of bed by using the wedge form pillow on the gastro-esophageal reflux symptoms among patients who had underwent esophagectomy and reconstruction.
Method:The research employed a cross-over design with one week as the intervention time. The same intervention was adopted for all participants after two weeks, with a longitudinal follow-up to review any difference between before intervention and at varied time points, including a period within 14 days and after one, two, and three months after the administration. The study was conducted in a medical center in Southern Taiwan. A list of qualified subjects was screened from the esophageal cancer database and randomized to two groups for drug administration by permuted block randomization. Data collection included self-reported reflux symptom, sleep quality and endoscopic changes of esophageal mucosa. Collected data were analyzed by descriptive statistics, linear mixed model.
Result:A total of 14 cases were included in this study. The results showed that the average score of reflux symptom by combination of medication and wedged pillow was reduced than that of single drug administration in 14 days. However, taking into account of measurement time and other controlled variables, it showed no statistical significance in the improvement of reflux symptoms. Further investigation on long-term improvement of reflux symptom by combination of medication and wedged pillow, the results showed continuous decrease in the score of reflux symptom in one, two, and three months with statistical significance, where the reflux symptom was reduced much more in the second month. In terms of sleep quality, the average of total score declined regardless of time over the three months. However, no statistical significance was reported. For endoscopic view of esophageal mucosal injury, 11 patients (84.6%) showed above average improvement, but 2 (16.7%) patients' condition exaggerated after administration. Fourteen patients felt satisfactory with wedged pillow.
Conclusion and Clinical Recommendations: Single drug administration or drug/wedged pillow combination wedge improved the reflux symptoms, but both had limited effectiveness in improving sleep quality. It is recommended that in addition to focusing on recurrence of esophageal cancer disease, surgeons should pay attention to the symptom of GE reflux and arrange regularly endoscopic examination to confirm the presence of reflux esophagitis in these patients. They should be prescribed with proper medication and taught to control their lifestyle and diet intake after opertaion. Furthermore, by industry-academic cooperation, an ergonomic design of wedged pillow can be produced in accordance with individual body to reduce reflux at nighttime to improve the quality of life.
論文目次 中文摘要 I
英文摘要 III
誌謝 V
目錄. i
表目錄. iv
圖目錄. v
第一章 緒論. 1
第一節 研究背景 1
第二節 研究動機及重要性 3
第三節 研究目的 5
第四節 研究假設 5
第二章 文獻查證 6
第一節 食道癌概述 6
第二節 食道癌的治療方式 7
第三節 食道癌術後功能性疾病 10
第四節 食道癌術後逆流症狀的處理方式 15
第三章 研究架構 21
第四章 研究方法 22
第一節 名詞界定 22
第二節 研究設計 24
第三節 研究場域及對象 26
第四節 實驗介入措施 27
第五節 研究工具 29
第六節 研究計畫執行流程33
第七節 資料分析方法 35
第八節 倫理考量 36
第五章 研究結果 37
第一節 研究個案基本屬性與疾病特性37
第二節 研究個案逆流症狀、睡眠品質與內視鏡食道黏膜之現況41
第三節 藥物合併楔型枕與單純藥物兩組逆流症狀改善之比較44
第四節 藥物合併楔型枕介入對介入三個月後逆流症狀之改善成效 49
第五節 藥物合併楔型枕介入對介入三個月後睡眠品質之改善成效 51
第六節 藥物合併楔型枕介入對介入三個月後內視鏡食道黏膜之改善成效53
第七節 楔型枕使用滿意度分析54
第六章 討論 55
第一節 研究個案基本屬性與疾病特性55
第二節 藥物合併楔型枕對逆流症狀的影響56
第三節 藥物合併楔型枕對睡眠品質的影響59
第四節 藥物合併楔型枕對內視鏡食道黏膜損傷的影響60
第五節 楔型枕使用滿意度62
第七章 結論、研究限制與建議 63
第一節 結論63
第二節 研究限制63
第三節 未來研究方向與建議64
參考文獻 68
附件目錄 79
附件一 同意人體研究同意書79
附件二 逆流症狀問卷日本作者同意函80
附件三 逆流症狀問卷中文翻譯作者同意函81
附件四 中文版匹茲堡睡眠品質量表中文作者同意函82
附件五 基本資料問卷83
附件六 逆流症狀問卷84
附件七 中文版匹茲堡睡眠品質量表85
附件八 自我監測日誌87
附件九 標準訪談內容88
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