心臟衰竭住院病人症狀與日常功能狀態之相關性探討

心臟衰竭屬於漸進性且持續一生的慢性病， 90%以上心臟衰竭病人會經歷2-6種身體症狀困擾，不僅影響患者生理、心理及生活品質，更會造成家人及社會上的負擔，進而影響日常活動功能狀態，若能了解影響心臟衰竭病人之日常活動功能狀態之相關因素，將有助於日後照護服務之參考。本研究目的為：（1）了解心臟衰竭病人之個人屬性、症狀、日常功能狀態；（2）探討心臟衰竭病人個人屬性與心臟衰竭症狀之差異性；（3）探討心臟衰竭病人個人屬性與日常功能狀態之差異性；（4）探討心臟衰竭病人症狀與日常功能狀態之相關性；（5）探討心衰竭病人日常功能狀態的預測因子。本研究為橫斷式相關性研究設計（cross-sectional correlational study），採方便取樣，以台南市某醫學中心內科病房之心臟衰竭病人為研究對象，共收集110位病人，由研究者翻閱病歷收集病人資料，並以問卷作調查，包括個人基本資料、心臟衰竭症狀評估量表、日常功能狀態等量表進行調查。量表經信、效度檢定，包括內部一致性信度、再測信度、表面效度及內容效度。所得到之資料以SPSS 18.0及JMP 12套裝軟體，進行百分比、平均值、標準差、t檢定、單因子變異數分析、皮爾森積差相關及逐步複回歸之分析。本研究結果發現（1）心臟衰竭症狀前五名，依序為:呼吸喘、體力受限、夜間喘不過氣醒來、平躺時呼吸困難、與腿或是手臂水腫；（2）紐約心臟功能分級、年齡、教育程度、罹患疾病病數、就業狀況、及睡眠狀況對症狀及日常功能狀態有顯著性差異。（3）回憶式心臟衰竭症狀評估量表得分，症狀發生頻率:73/440分、嚴重程度:58/440分、困擾程度:58/440分，屬於低程度的影響；（4）日常功能狀態之基本日常活動:63.3分、工具性日常活動:44.1分、心理健康:48.6分，社會/角色功能:50.6分，皆在警戒區範圍內，屬於低日常生活狀態；（5）「紐約心臟功能分級」、「年齡」、「症狀發生頻率」、「睡眠時數」、及「職業」為影響基本日常活動功能狀態的預測因子，可解釋49%總變異量；「症狀發生頻率」、「紐約心臟功能分級」、「職業」、「睡眠時數」及「年齡」為影響工具性日常活動功能狀態的預測因子，可解釋57%總變異量；「症狀發生頻率」為影響心理健康功能狀態的預測因子，可解釋19%總變異量；「症狀發生頻率」、「職業」、「睡眠時數」及「紐約心臟功能分級」為影響社會/角色功能狀態的預測因子，可解釋60%總變異量。本研究結果可提供臨床照護人員實證資料，作為病人出院轉準備的評估，與照護參考依據，有關心臟衰竭症狀與日常功能狀態，進而促進其生活品質。

關鍵字

心臟衰竭病人；症狀；日常功能狀態

並列摘要

Heart failure is a progressive chronic disease that lasts a lifetime, a mutual and final condition of all heart diseases. More than 90% heart failure patients experience 2 to 6 physical symptoms, which not only affect the physiology, psychology, and life qualities of patients but also impose burdens on their families and the society, having an impact on the function status of their daily activities. Exploring the related factors of the function status of heart failure patients’ daily activities can serve as a reference for future care service. The aims of this study included: (1)to explor the personal attributes, symptoms, and daily function status of heart failure patients; (2)to investigate the difference between personal attributes of heart failure patients and heart failure symptoms; (3) to investigate the difference between personal attributes of heart failure patients and daily function status; (4)to investigate the correlation between the symptoms and daily function status of heart failure patients; (5) to investigate the predictors of influcing the daily function status of heart failure patients. The study was a cross-sectional correlational study, and it adopted a convenience sampling. The research subjects were the heart failure patients in the medical ward of a medical center in Tainan City, and 110 patients were collected. The researcher read the medical records, collected the data records of the patients, and interviewed survey questionnaires, which included personal information, Mmorial Symptoms Asscement Scale - Heart Failure, and a survey on daily function status. The reliability and validity of the assessment tools were tested, including internal consistency reliability, test-retest reliability, face validity, and. The data received was analyzed with percentage, mean, Standard Deviation, T-test, one-way analysis of variance (ANOVA) , Pearson product-moment correlation, and Stepwise multiple regression by the softwares of SPSS 18.0, JMP 12. The findings of the study were as following: (1) the top 5 symptoms of heart failure were shortness of breath, limitations on physical strength, feeling out of breath and waking up at night, dyspnea when lying down, and swelling in legs or arms; (2) there were significant statistics differences between symptoms and daily function status because of the classification of New York Heart association of heart failure, age, levels of education, numbers of chronic diseases , employment status, and sleep conditions; (3) regarding the scores in the Memorial Symptoms Asscement Scale-Heart Failure Tool, frequency of symptom occurrence was 73/440, level of severity 58/440, and degree of distress 58/440, which were low level influence on the heart failure patients; (4) daily function status and Activities of Daily Living (ADL): 63.3score, Instrumental Activities of Daily Living (IADL): 44.1 score, mental health: 48.6 score, and social roles and functions: 50.6 score, which belonged to the low conditions of daily life; (5) the classification of New York Heart association of heart failure, age, frequency of symptom occurrence, hours of sleep, and occupation on the patients were the predictors that affected the function status of Activities of Daily Living (ADL), and they explained 49% of the total variance of ADL. Frequency of symptom occurrence, the classification of New York Heart association of heart failure, occupation, hours of sleep, and age were the predictors that affected the function ststus of Instrumental Activities of Daily Living (IADL), and they explained 57% of the total variance of IADL. Frequency of symptom occurrence was the predictor that affected the function status of mental health, explaining 19% of the total variance. Frequency of symptom occurrence, occupation, hours of sleep, and the classification of New York Heart association of heart failure were the predictors that affected the function status of social roles and functions, explaining 60% of the total variance. The results of this study, which probed into the symptoms and daily function status of heart failure inpatients, could provide the reference of clinical care with empirical data, help the evaluation of discharge planning, and serve as the reference for care service to promote the quality of life of patients.