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  • 學位論文

慢性腎臟病照護管理對糖尿病生活品質之影響

The Study on Quality of Life of Diabetes Mellitus Patients Under Chronic Kidney Disease Care Management Program

指導教授 : 郭乃文 黃崇謙

摘要


由於糖尿病是國際間盛行率高的慢性疾病,台灣地區在糖尿病與慢性腎臟病人口數不斷的攀升之下,皆進入十大死因之列,而腎病變又是糖尿病好發之併發症,佔透析人口的比率之最,可推估糖尿腎病變已成為慢性腎臟病的高危險群,不僅造成醫療資源的耗用,亦全面衝擊國人健康,造成生活品質下降,然國內外的研究皆證實生活品質是預測慢性疾病之死亡及住院率的重要因子,更顯得生活品質對糖尿腎病變個案之重要性,本研究之目的,在探討慢性腎臟病照護管理對糖尿病生活品質之影響。 本研究以北部某醫學中心107位第2型糖尿病診斷有糖尿腎病變病人為對象,採立意取樣方式,以隨機抽籤方式,分為對照組與實驗組,收案期間:由2010年9月至2011年3月止,並以台灣版「D39-TAIWAN ®生活品質量表」為測量工具。經人口學特性、疾病特性及照護種類及生活品質等變項,探討不同的照護方式對生活品質之影響。 研究結果發現:(1)接受慢性腎臟病CKD照護管理(含糖尿腎病變自我照護課程)之個案,在D-39健康生活品質之五大面向的統計分析發現:糖尿病控制、社會與同儕壓力、性功能等面向,達到統計學上的顯著差異。(2)臨床生化指標:醣化血色素及腎絲球過濾率亦達到統計學上的顯著差異,而肌酸酐、微量白蛋白尿等生化數值,雖未達顯著差異,但皆呈現下降的趨勢。(3)個案就D-39健康生活品質之面向分析發現:活力與活動力、社會與同儕壓力、性功能等面向達統計學上的顯著差異。(4)就整體生活品質而言,糖尿腎病變個案之整體健康生活品質於統計學分析亦達顯著差異。本研究對象雖多數屬中高年齡層,處於退休狀態且教育程度偏低,但經由慢性腎臟病CKD照護系統性介入,透過醫護人員的教育、監測及正面的鼓勵,增強了自我照顧的信心、確實遵從醫療處置、強化自我疾病管理的照護技巧與疾病共存信念等,進而潛在性影響日常生活的健康行為改變,達到生活品質提升及自我疾病管理技巧之應用,亦證實了接受慢性腎臟病CKD照護的改善成效。

並列摘要


The significance of this study originated from noticing of the Diabetes Mellitus (DM) prevalence rates are climbing among all chronic diseases internationally. The Taiwanese DM and Chronic Kidney disease (CKD) populations are both listed in top ten causes of death, and these in turns threatening every country's health care system and further compounded with financial burden and profound social consequences. Taiwanese DM-induced CKD patients are on top of the international comparison and severely impacted our health status and quality of life (QoL). Both Taiwanese and international studies showed that QoL is an important factor predicting the future hospitalization and death for chronic diseases. Hence, QoL should matters to DM-CKD patients gravely too. The purpose of this study is on exploring the QoL of Diabetes Mellitus patients under Chronic Kidney Disease care management program.This study sampled 107 subjects in a medical center in northern Taipei with Type 2 DM patients diagnosed with CKD. It uses subjective selection to divide them into study group and comparison group by random drawing. The study period started from September 2010 and ended on March 2011. It uses the D-39 TAIWAN ® structured questionnaire as a measurement tool to evaluate how different care format will impact on QoL, with adjustments of demographic factors, disease characteristics, care format and QoL. The study results showed: (1) for the group under CKD care management (including DM-CKD Self Care lessons), with D-39's five QoL aspects statistical analysis, showed significant differences with respect to diabetes control, social / peer burden and sexual functioning. (2) clinical bio-chemical indicators, HBA1c, eGRF, were statistically positively correlated. However, the Creatinine, microalbuminuria may not be significantly different, but both are declining too. (3) subjects responded positively significant with respect to D-39 QoL analysis on vitality and mobility, social / peer burden and sexual functioning. (4) The overall QoL, the case of Diabetic Nephropathy, general health quality of life is significantly different in the statistical analysis. Even though most of the subjects within the study are senior citizens who are retired and relatively less educated, but by means of CKD Care Management intervention on training, monitoring and positive reinforcement, they build Self-care confidence, proper medical compliance, improved self care skills and belief with mutual existence with the disease. Furthermore, they implicitly improved the daily health behavior, better QoL and applied self disease management, which in turns confirms the effectiveness of CKD care efforts.

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