背景: 僧帽瓣脫垂是常見的瓣膜性心臟病,盛行率為2-22%,好發於年輕女性。患者常主訴許多令人感到不愉悅的臨床症狀,例如頭暈、心悸、疲憊、胸痛、焦慮…等非特異性的症狀。當僧帽瓣脫垂患者有一個或一個以上的症狀表現且症狀與僧帽瓣結構改變無關時,稱之為僧帽瓣脫垂症候群(mitral valve prolapse syndrome, MVPS)。 目的: 本研究根據不愉快症狀理論(Theory of unpleasant symptoms, TOUS),探討僧帽瓣脫垂症候群患者生理、心理及情境因素與症狀之關係,了解MVPS症狀的發生頻率、嚴重度及對生活困擾的程度。 方法: 本研究為描述性相關研究,立意取樣南台灣一所教學醫院20歲以上僧帽瓣脫垂症候群女性共41位,完成人口學特性基本資料表、僧帽瓣脫垂症狀評估表、貝克焦慮量表、中文版三日身體活動回憶記錄表及心率變異度等資料收集。以統計軟體SPSS 17.0 for Windows 進行百分比、平均值、標準差、皮爾森相關檢定(Pearson’s Correlation)、斯皮爾曼相關檢定(Spearson’s Correlation)、t檢定(t-test)、曼-惠特尼U檢定(Mann-Whitney U test)、K-W檢定(Kruskal-Wallis test)及階層迴歸(hierarchical regression)等統計方式分析。 結果: 本研究結果發現41位個案之平均身體質量指數低於正常體重範圍、身體活動量較低且大部份個案之LF/HF比值低於建議值範圍。焦慮程度與MVPS症狀發生頻率(r=.55,p<.001)、症狀嚴重度(r=.53,p<.001)及症狀對生活困擾程度(r=.64,p<.001)皆有顯著正相關,焦慮為MVPS之重要影響因子。 結論: MVPS患者有輕度到中度之焦慮且影響症狀表現,多數患者身體活動量較低,建議臨床醫護人員運用TOUS理論,針對MVPS患者進行多面向評估,透過心理衛生教育及相關護理措施減緩MVPS患者焦慮程度,提升身體活動量,改善MVPS患者之症狀。
Mitral valve prolapse is a common vavular heart disease, with prevalence estimates generally ranging from 2 to 22 % and more common in women than in men. Mitral valve prolapse is frequently with a constellation of symptoms. Patients are diagnosed mitral valve prolapse syndrome (MVPS) whensymptoms are not related to structural change. Common MVPS includes chest pain, anxiety, palpitation, fatigue, dizziness, dyspnea, mood swings, and headache. The purpose of this study is based on theory of unpleasant symptoms to investigate: (1) intensity, timing, distress of MVPS, (2) the relationship among MVPS and associated physiological, psychological and situational factors, (3) important predictors of MVPS. A descriptive cross-sectional and correlation study design was used. The study included female patients above 20-year-old with mitral valve prolapse syndrome from a region hospital. A sample of 41 cases completed a demographic check list, MVPS symptom check list, ChineseBeck Anxiety Inventory, Chinese 3-day Physical Activity Recall record, and CheckMyHeart Handheld HRV 3.0 exam. Descriptive statistics, Pearson's and Spearman's correlation analysis, Student T test, Mann-Whitney U test, Kruskal-Wallis test, and hierarchical regression analysis were done with SPSS 17.0 software to answer the research questions. This study found that female patients with MVPS have low BMI, sedentary lifestyle, and majorly with low LF/HF ratio. Anxiety is significantly correlated with frequency of MVPS (r=.55,p<.001), severity of MVPS (r=.53,p<.001) and MVPS related life distress (r=.64,p<.001). Also, anxiety is the most important predictive factor of MVPS symptoms. These results suggested that clinical medical and nursing staffs could adopt the TOUS to develop multi-dimensional clinical assessment, apply nonpharmacological interventions in relieving the level of anxiety and encourage physical activity in order to reduce MVPS symptoms.
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