慢性阻塞性肺疾病之生理症狀群集

Physical Symptom Clusters of Chronic Obstructive Pulmonary Disease

林韋君(Wei-Chun Lin) ； 黃翠媛(Tsuey-Yuan Huang) ； 黃秀梨(Shiow-Li Hwang)

《領導護理》 20卷2期 (2019/06) Pp. 24-41

https://doi.org/10.29494/LN.201906_20(2).0003

摘要

慢性阻塞性肺疾病（Chronic obstructive pulmonary disease，COPD）病人會出現至少一個與呼吸道關聯的症狀，這些相關的症狀會相互作用與影響，形成症狀群集造成功能狀態與生活品質的損害。本研究旨在探討COPD病人症狀群集現象。以橫斷式相關性研究設計，於中台灣某醫學中心，經由胸腔內科醫師確定診斷為COPD者為研究對象，以回憶症狀量表（Memorial Symptom Assessment Scale，MASA）收集症狀經驗之資料。共139人完成問卷調查，多數為男性133位（95.7%），平均年齡71.79±10.23歲。平均而言COPD病人有6.71±4.79個症狀，盛行率最高的症狀為咳嗽90.65%；其次為缺乏活力61.15%；再者為呼吸困難58.99%。階層群集分析結果顯示，COPD所經驗的生理症狀可分為四組症狀群集，分別為群集一：呼吸道症狀及疲憊、群集二：感官不適及精神狀態相關症狀、群集三：排泄系統及食慾相關症狀，及群集四：營養相關症狀。COPD之症狀經驗是複雜的，同時受到多個症狀的困擾；在執行症狀評估時，應以症狀群集概念為基礎，採取多層面的評估，本研究之發現可做為醫護人員症狀處理及制訂護理介入措施之依據，以提供患者適切的照護活動以改善健康狀態。

關鍵字

慢性阻塞性肺疾病 ； 症狀群集 ； 症狀困擾

並列摘要

Patients with Chronic obstructive pulmonary disease (COPD) suffer from one or more symptoms associated with respiratory tract. These symptoms may interact with the others and form a ＂symptom cluster＂ to further result in defect of functional status as well as quality of life. The aim of this study is to explore the symptom clusters of patients with COPD, via cross-sectional & descriptive-correlation design used to examine patients' symptom experiences by Memorial Symptom Assessment Scale (MSAS) and collected the data from a medical center in central Taiwan. A total of 139 surveys were collected in this study. The surveyed samples were predominantly men (95.7 %), with a median age of 71.79 ± 10.23 years. In average, patients with COPD experienced many symptoms (6.71 ± 4.79), the most common physical symptoms were cough (90.65 %), lack of energy (61.15 %), and dyspnea (58.99 %). Hierarchical cluster analysis revealed symptoms groups into 4 distinct clusters: firstly, respiratory tract symptoms and fatigue; secondly, sensory discomfort and mental status related symptoms, symptoms related to excretory system and appetite; thirdly symptoms related to excretion system and appetite; lastly, nutrition related symptoms. Experiences from symptom in patients with COPD are complex. They can suffer distress from more than one symptom simultaneously. For the patients with COPD, the assessment for symptoms should be determined on multidimensional concepts of symptom cluster. The findings of this study provide a foundation for symptoms management and nursing interventions to improve health status and quality of life for patients with COPD.

並列關鍵字

Chronic obstructive pulmonary disease (COPD) ； Symptom cluster ； Symptom distress

參考文獻

Polit, D. F., & Beck, C. T. (2006). The content validity index: are you sure you know what's being reported? Critique and recommendations. Research in Nursing & Health, 29(5), 489-497. doi:10.1002/nur.20147

Stridsman, C., Lindberg, A., & Skar, L. (2014). Fatigue in chronic obstructive pulmonary disease: a qualitative study of people's experiences. Scandinavian Journal of Caring Sciences, 28(1), 130-138. doi:10.1111/scs.12033

Stridsman, C., Mullerova, H., Skar, L., & Lindberg, A. (2013). Fatigue in COPD and the impact of respiratory symptoms and heart disease--a population-based study. Journal of Chronic Obstructive Pulmonary Disease, 10(2), 125-132. doi:10.3109/15412555.2012.728642

Theander, K., Hasselgren, M., Luhr, K., Eckerblad, J., Unosson, M., & Karlsson, I. (2014). Symptoms and impact of symptoms on function and health in patients with chronic obstructive pulmonary disease and chronic heart failure in primary health care. International Journal of Chronic Obstructive Pulmonary Disease, 9, 785-794. doi:10.2147/COPD.S62563

van Dam van Isselt, E. F., Groenewegen- Sipkema, K. H., Spruit-van Eijk, M., Chavannes, N. H., de Waal, M. W., Janssen, D. J., & Achterberg, W. P. (2014). Pain in patients with COPD: a systematic review and meta-analysis. BMJ Open, 4(9), e005898. doi:10.1136/bmjopen- 2014-005898