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系統識別號 U0026-2102201809432100
論文名稱(中文) 婦癌術後下肢淋巴水腫與睡眠困擾、疲憊及憂鬱的關係
論文名稱(英文) The Relationships among Lower Limb Lymphedema, Sleep Disturbance, Fatigue and Depression in Gynecological Cancer Women after Surgery
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 106
學期 1
出版年 107
研究生(中文) 劉珈瑜
研究生(英文) Chia-Yu Liu
學號 T26034066
學位類別 碩士
語文別 中文
論文頁數 99頁
口試委員 指導教授-許玉雲
口試委員-陸偉明
口試委員-許耿福
中文關鍵字 婦科癌症  下肢淋巴水腫  睡眠困擾  疲憊  憂鬱 
英文關鍵字 Gynecological cancer  Lower Limb Lymphedema  Sleep Disturbance  Fatigue  Depression 
學科別分類
中文摘要 中文摘要
研究背景:婦科癌症的治療主要為手術合併淋巴結摘除術,雖然手術治療可以提高婦癌患者的存活率,但約有5-49%患者發生下肢淋巴水腫。下肢淋巴水腫使病患深受其所產生之症狀困擾,如外觀改變、腫脹、疼痛等,進而產生睡眠、疲憊及心理問題,然而目前國內外尚無針對下肢淋巴水腫症狀與睡眠、疲憊與憂鬱之間的關係,進行統合性的模式建構。
研究目的:探討影響下肢淋巴水腫的個人與健康因素,以及下肢淋巴水腫對睡眠困擾、疲憊與憂鬱的關係,並驗證睡眠困擾與疲憊為下肢淋巴水腫與憂鬱之間的中介變項。
研究方法:本研究為次級資料分析,母研究為橫斷式研究設計,採方便取樣,於2016年2月至2017年11月於台灣南部某醫學中心進行收案。研究採自填式問卷及病歷回顧方式共收案200位接受婦科癌症手術合併淋巴結摘除的婦女,問卷內容包含人口學變項、醫療相關變項、下肢淋巴水腫功能障礙、睡眠困擾、疲憊與憂鬱。
研究結果:60% (n=120)研究對象表示有下肢淋巴水腫功能障礙,且59% (n=118)研究對象因此活動受限;年齡大於55歲者(p<.05)、術後時間較短(p<.05)與有接受化學治療者(p<.05)更容易發生下肢淋巴水腫功能障礙;下肢淋巴水腫功能障礙與身體質量指數、癌症種類、癌症分期、移除淋巴結部位與數目、是否接受放射線治療無呈現顯著相關;下肢淋巴水腫對睡眠困擾、疲憊有正向影響,然而下肢淋巴水腫功能障礙需透過中介變項「睡眠困擾」與「疲憊」間接影響憂鬱狀態。
研究結論:年齡較大、術後時間較短與接受化學治療為下肢淋巴水腫功能障礙之影響因子,而下肢淋巴水腫功能障礙不僅造成患者症狀困擾及活動力受限之外,亦可能造成患者睡眠困擾與疲憊,進而導致憂鬱狀態。
英文摘要 The study is to explore the risk factors of lower limb lymphedema, and to establish a model of the relationships among lower limb lymphedema, sleep disturbance, fatigue and depression among gynecological cancer women after surgery. The study intended to examine whether the sleep disturbance or fatigue is the mediator of the relationship between lower limb lymphedema and depression. Methods: The study is a secondary data analysis. The primary research recruited 200 women who were above 20 years old, diagnosed with gynecological cancer and treated with pelvic lymphadenectomy. Participants were asked to fill out the questionnaires: Lymphoedema Functioning, Disability and Health Questionnaire for Lower Limb Lymphoedema (Lymph-ICF-LL), General Sleep Disturbance Scale (GSDS), Numerical Rating Scale for Fatigue (NRSF), and Center for Epidemiologic Studies Depression Scale (C-ESD). Results: Age <55 years old, shorter duration of surgery and receiving chemotherapy were found to be independently associated with lower lymphedema. Of the 200 participants, 60% suffered from lower limb lymphedema with differently functional impairment, and 59% experienced the movement limitation. Lower limb lymphedema has positive relationships with sleep disturbance and fatigue. Furthermore, both sleep disturbance and fatigue completely mediated the relationships between lower limb lymphedema and depression. Conclusion: Age <55 years old, shorter duration after surgery and receiving chemotherapy are significant risk factors for lower limb lymphedema. The findings of this study illustrate the comprehensive information about lower limb lymphedema and its relationship with fatigue, sleep disturbance and depression. Healthcare providers can improve depression symptoms among patients with lymphedema in terms of relieving their fatigue and sleep disturbance.
論文目次 目錄
考試合格證明 ……………………………………………………………………Ⅰ
中文摘要 ……………………………………………………………………………Ⅱ
英文摘要 ……………………………………………………………………………Ⅳ
誌謝 ……………………………………………………………………………………Ⅷ
目錄 ……………………………………………………………………………………Ⅹ
附錄目錄 …………………………………………………………………………ⅩⅡ
表目錄 ………………………………………………………………………………ⅩⅢ
圖目錄 ………………………………………………………………………………ⅩⅣ

一、緒論……………………………………………………………………………………1
第一節、背景 ……………………………………………………………………1
第二節、研究重要性 ………………………………………………………2
第三節、研究目的 ……………………………………………………………3

二、文獻查證………………………………………………………………………………4
第一節、 淋巴系統循環生理學 …………………………………………4
第二節、 淋巴水腫簡介 ………………………………………………………6
第三節、 影響婦科癌症手術與下肢淋巴水腫發生的相關因子 …………………8
第四節、 婦女癌症患者的睡眠困擾…………………………………13
第五節、 婦女癌症患者的疲憊……………………………………………15
第六節、 婦女癌症患者的憂鬱……………………………………………17
第七節、 婦女癌症患者下肢淋巴水腫與睡眠困擾、疲憊、憂鬱……………18

三、研究方法 ……………………………………………………………………………20
第一節、 理論架構…………………………………………………………………20
第二節、 研究架構…………………………………………………………………21
第三節、 研究假設…………………………………………………………………22
第四節、 名詞定義…………………………………………………………………23
第五節、 研究設計…………………………………………………………………27
第六節、 研究對象…………………………………………………………………28
第七節、 研究工具…………………………………………………………………29
第八節、 統計分析…………………………………………………………………32
第九節、 研究對象權益維護………………………………………………………33

四、研究結果 ……………………………………………………………………………34
第一節、 婦科癌症術後患者基本人口學變項與醫療相關變項之描述性統
計分析…………………………………………………………………………35
第二節、 婦科癌症術後患者睡眠困擾、疲憊與憂鬱之描述性統計分
析……………………………………………………………………………………41
第三節、 婦科癌症術後患者下肢淋巴水腫之影響因素分析……………………50
第四節、 婦科癌症術後患者下肢淋巴水腫與睡眠困擾、疲憊與憂鬱之相
關分析……………………………………………………………………………55
第五節、 下肢淋巴水腫、睡眠困擾、疲憊與憂鬱之理論模式分析………57

五、研究討論與結論 ……………………………………………………………………63
第一節、 研究結果討論…………………………………………………………………64
第二節、 研究限制與未來研究方向…………………………………………72
第三節、 實務應用與建議……………………………………………………………73
第四節、 結論……………………………………………………………………………………75

參考文獻 …………………………………………………………………………………77
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