糖尿病引發視網膜病變及神經病變對生活品質的衝擊

The Impact of Diabetic Related Retinopathy and Neuropathy on Patients` Quality of Life

蔡璧玲(Pi-Ling Tsai)

指導教授 ： 賴裕和 教授

國立臺灣大學/醫學院/護理學研究所/碩士(2009年)

https://doi.org/10.6342/NTU.2009.01937

摘要

隨著全球糖尿病人口不斷增加，糖尿病造成的視網膜病變及神經病變對個人健康或國家而言都是一個沉重的負擔，當視網膜病變及神經病變存在時病情會不斷進展，影響病人生活品質，另外視力模糊又伴隨肢體麻、痛情況下，有可能增加跌倒危險性造成進一步傷害。本研究之目的主要探討糖尿病引起的視網膜病變及神經病變對病患生活品質影響及其是否增加病患跌倒危險性。研究方法為橫斷式調查法（Cross-Sectional Survey），採結構式問卷進行資料收集，以「NEI VFQ-25量表」評估視覺相關生活品質、「SF-12問卷」測量個案一般生活品質及「密西根量表」檢查個案神經病變程度，收案地點在北市某家醫學中心眼科門診，收案時間98年3月至6月間，收案數共200名，研究結果顯示糖尿病視網膜病變患者視覺相關生活品質，主要受雙眼較差側視力及雙眼視差之影響（p＜.01），NEI VFQ-25項目中，除了眼睛疼痛外，其他次項目都與較差視力呈現有意義相關；周邊神經病變病人主觀感受之症狀方面，以麻、刺痛感最常見，足部檢測 (醫護人員評估)則以末稍觸覺異常佔多數，視網膜病變合併周邊神經病變病人一般生活品質許多層面都有影響（p＜.001）；以logistic regression 同時分析神經性病變與視網膜病變及平衡程度對於跌倒之影響，將雙眼視力轉換為LogMar值後分析，結果發現:與雙眼視差在0.6以下且MNSI足部檢測小於四分者相比（a）雙眼視差在0.6以上且MNSI足部檢測大於四分者，其跌倒危險比為3倍（Odds ratio=3.0 ）；（b）雙眼視差在0.6以上且MNSI足部檢測小於四分者，其跌倒危險比為2.71倍（Odds ratio=2.71）；（c）視差在0.6以下且MNSI足部檢測大於四分者，其跌倒危險比為2.61倍（Odds ratio=2.61 ）。本研究有助臨床護理人員瞭解糖尿病視網膜病變及周邊神經病變對病人生活品質影響層面，並對視網膜病變及周邊神經病變對跌倒危險性有進一步了解，以提供臨床照護依據提升病人生活品質及減少跌倒發生。

關鍵字

糖尿病 ； 視網膜病變 ； 神經病變 ； 健康相關生活品質 ； 跌倒

並列摘要

In view of the increasing prevalence of diabetes mellitus worldwide, diabetes mellitus (DM) induce retinopathy and neuropathy are a huge burden for persons and countries. Diabetic retinopathy and neuropathy are known to influence patients’ quality of life and safety, such as falling. However, lack of information have known in this field. Thus, the purposes of the study were to examine (1) the diabetic induce retinopathy and neuropathy and their impact on patients` life quality; and (2) the influence of DM induced neuropathy and retinopathy on patients’ falling. A cross-sectional study was conducted in a medical center in Taipei. A total of 200 diabetic retinopathy were recruited. Data was collected by National Eye Institute Vision Function Questionnaire（NEI VFQ-25）, 12-item short-form（SF-12）, Michigan Neuropathy Screening Instrument（MNSI）. The findings showed that（1）diabetic retinopathy’s vision related quality of life affect by worse-seeing eye, subscale of vision related quality of life and visual acuity are significantly (p<.01)except for ocular pain subscale. (2） The most common diabetic neuropathy sensory symptom is pain and numbness. The most common abnormal neuropathy sign was light touch sense.（3）Generally, patients’ quality of life (SF-12) is significantly related to the severity of patients’ retinopathy and neuropathy(p<.001).（4）Simultaneously calculating patients’ severity of neuropathy, retinopathy and balance ability on possibility of falling analyzed by logistic regression found: compare to binocular visual acuity difference＜0.6 and MNSI clinical examination score＜4 (a) MNSI clinical examination score＞4 and binocular visual acuity difference > 0.6 the fall risk odds ratio=3;(b) MNSI clinical examination score <4 and binocular visual acuity difference > 0.6 the fall risk odds ratio=2.71;(c) MNSI clinical examination score＞4 and binocular visual acuity difference <0.6 the fall risk odds ratio=2.61. The study provide information about diabetic retinopathy and neuropathy impact quality of life. We also provide further evidence the risk of falling among retinopathy and neuropathy. Overall we hope that the finding will improve the quality of life and reduce falls.

並列關鍵字

diabetes ； diabetic retinopathy ； diabetic neuropathy ； quality of life ； falls

參考文獻

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