膀胱再訓練對改善膀胱過動症婦女症狀及生活品質之成效研究

The effects of bladder retraining on the improvement of symptoms and quality of life among women with overactive bladder

張素容(Su-Jung Chang)

指導教授 ： 李淑杏

中山醫學大學/護理學院/護理研究所/碩士(2009年)

https://doi.org/10.6834/CSMU.2009.00127

摘要

本研究目的是測試膀胱再訓練對膀胱過動症婦女的症狀、生活品質及生活衝擊之介入成效。採實驗性研究法，研究對象為至中部某醫學中心求診的個案，診斷為膀胱過動症，年齡在18歲以上的女性，收案期間於民國96年10月至97年9月間，以個案病歷號碼單雙號差異，將個案分為實驗組和控制組，實驗組收案45人、控制組收案33人，總計收案78人。實驗介入時間為八週，實驗組個案予膀胱再訓練；控制組則只填寫解尿日記。評估指標包括主觀性和客觀性指標，前者以台灣簡明版世界衛生組織生活品質問卷及尿失禁生活衝擊量表測量，以了解個案主觀判斷解尿狀況對日常生活的影響和生活品質的改善情形；後者以解尿日記測量，包括頻尿、夜尿、尿急感、因尿急而漏尿的次數。資料於實驗開始前收集一次，作為前測值；於實驗介入結束再收集一次，作為後測值。研究收集資料經編碼後，以SPSS13.0版套裝軟體進行統計分析，以臨界值小於.05為可接受的顯著水準。實驗介入八週之結果顯示：(1)實驗組和控制組的頻尿與夜尿兩項，皆有明顯的改善(實驗組p< .01, 控制組p< .05 )，但尿急感、尿急性尿失禁兩項，其前後測無差異。(2)實驗組經膀胱再訓練後，其生活品質總分、生理、心理、社會關係及環境範疇，其品質分數皆有明顯提升，皆達統計差異水準(p< .01)，其中又以心理範疇改善最多。控制組則在環境範疇有改善(p< .05 )。(3)實驗組和控制組生活衝擊總分，在前測和後測，皆屬低程度衝擊。實驗組於旅遊活動、社交活動、身體活動和情緒安適活動四大類，其生活衝擊皆獲得明顯的改善，且達顯著差異(p< .01)。本研究結果顯示膀胱再訓練療程對OAB婦女的症狀、生活品質及生活衝擊有改善之成效，期能將此結果推廣運用於需要重建排尿行為的個案，亦期望有更多護理同仁投入護理專業的實驗性研究。

關鍵字

膀胱過動症 ； 膀胱再訓練 ； 生活品質 ； 生活衝擊

並列摘要

The aim of the study is to examine the effects of bladder retraining on symptoms and quality of life among women with overactive bladder (OAB).
An experimental design was applied to conduct the research. The subjects recruit who were diagnosed as OAB. In this controlled trial, a total of 78 women were selected from a medical center hospital OPD during October 2007 and September 2008. Subjects were purposely assigned to experimental group or control group by chart number, and a bladder retraining program including pelvic floor muscle exercise training, delayed voiding, time voiding and urge strategy was used as an intervention for experimental group. They visited the urinary incontinence clinic biweekly, and were treated with the bladder retraining program for 2 months, while the subjects in the control group were asked to keep bladder diary without bladder retraining program. The outcome measures included self-grading WHO Quality of life score and Incontinence Impact Questionnaire (IIQ) scales for measuring changes of quantity of incontinence impact and quality of life. The outcome measures will be administrated twice; prior to and after the study intervention. SPSS for Windows will be used to analyze the data. A p- value of < .05 was defined as being statistically significant.
The results showed that: (1) compared with pre-treatment data, there is a significant decrease in the times of urination in daytime (frequency) and night (nocturia) for both the experimental group or control group, but either urgency or urge incontinence was not improved. (2) In experimental group, four factors (physical, psychological, social, and environmental) of WHO quality of life questionnaire were improved significantly. In control group, the environmental factor was the only domain which showed significantly improved, (3) After eight weeks of bladder retraining, the degree of incontinence was decreased. The improvement on all four subscale (travel, social, activity and emotional) was statistical significance.
The results indicated that bladder retraining helped OAB women with the improvement in quality of life, and could be one of useful nursing competencies. It is recommended that nurse practitioners can use bladder retraining for patients who are in need.

並列關鍵字

overactive bladder ； bladder retraining ； quality of life ； incontinence impact

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