糖尿病患接受冠狀動脈繞道手術後治療遵從行為之探討

Exploration of Treatment Compliance Behaviors in Diabetic Patients Who Undergo Coronary Artery Bypass Graft Surgery

連如玉(Ru‐Yu Lien) ； 陳強儀(Chiang‐Yi Chen) ； 施俊哲(Chun‐Che Shih) ； 童恒新(Heng‐Hsin Tung)

《護理暨健康照護研究》 11卷2期 (2015/06) Pp. 137-147

https://doi.org/10.6225/JNHR.11.2.137

摘要

背　景：冠狀動脈繞道術後有10-20%復發率，造成再次手術原因多為無持續追蹤治療或未能改變不健康生活型態，不但生活品質無法真正提升，更可能耗費大量醫療成本。目　的：探討糖尿病合併冠狀動脈繞道手術後病患的治療遵從行為，了解病人治療遵從行為的解釋因子，以利醫護人員協助強化病人的醫療遵從性。方　法：採橫斷性調查立意取樣方式，以北部三家教學醫院之門診糖尿病患接受冠狀動脈繞道手術患者為對象，共166位。研究工具為自擬式基本資料問卷及心血管糖尿病治療遵從性量表問卷，資料收集後以SPSS 21.0進行統計分析。結　果：研究對象出現不遵從治療行為者有34.9%，於術後1-3年最多。遵從行為以飲食控制最佳，其次為藥物遵從，改變生活型態最差。能自我照顧者治療遵從性較佳，遵從性較佳者越能執行規則運動，冠狀動脈繞道手術後時間越久治療遵從性越佳，出現藥物副作用者遵從性較差。病患個人對目前生活環境的滿意程度、手術後時間以及是否出現藥物副作用，為治療遵從性行為的重要解釋因子，達統計上顯著意義（F=4.039, p=.046）。實務應用：醫療人員應提供返家後飲食控制之相關資訊，協助整個家庭的飲食行為的改變，促使病人藉由飲食控制建立健康的生活模式，另應讓病患瞭解與配合疾病控制必需的藥物應定時服用，建議病患改變生活型態方式，取代非必要的藥物治療，共同訂定可達成的運動計畫，以提升生活環境的滿意度，進而幫助病患自我強化治療遵從行為。

關鍵字

冠狀動脈繞道手術 ； 糖尿病 ； 治療遵從行為

並列摘要

Background: Coronary artery bypass surgery has an average recurrence rate of 10 to 20%, which generally results in the need for a reoperation and keeping close track of treatments and unhealthy lifestyle indicators. This situation negatively impacts the quality of life of patients and increases the costs of medical care. Purpose: This paper explores the factors related to the compliance behavior of post‐coronary‐bypass diabetes patients and develops a model to improve the healthcare and medical compliance of this population. Methods: This cross‐sectional study used convenience sampling to recruit diabetes patients who had received coronary artery bypass surgery at one of the largest medical hospitals in northern Taiwan. The 166 participants were asked to fill out a questionnaire that included questions on basic demographics, type of diabetes treatment, cardiovascular health status, and treatment compliance behavior. Results: A total of 34.9% of participants were identified with poor compliance behavior. Most non‐compliance behavior began to appear at 1 to 3 years post‐surgery. Patients with the best compliance behavior performed the best in the category of diet control followed by medication compliance. Lifestyle change was identified as the least important behavior. The results show that the longer the duration since CABG surgery treatment, the better that treatment compliance behaviors were. The findings also indicate that satisfaction with living environment, length of time since surgery, and the side effects of medication explained the variance in treatment compliance behaviors in participants (F=4.039, p=.046). Implications for Practice: Healthcare workers should teach family dietary changes and control. Patients should receive education on regular medication and healthy habits. Furthermore, programs that improve living conditions may help patients comply with appropriate behavior therapy.

並列關鍵字

coronary artery bypass graft ； diabetes mellitus ； treatment compliance behavior

參考文獻

林憶珊、楊南屏、周碧瑟（2009）‧第二型糖尿病患口服藥物服藥順應性相關因子之探討‧台灣家庭醫學雜誌，19(1)，24-35。[Lin, Y. S., Yang, N. P., & Chou, P. S. (2009). Drug adherence factors for type 2 diabetic patients. Taiwan Association of Family Medicine, 19(1), 24-35.]

陳淑美、林佩萱（2014）‧台灣老人居住安排與生活滿意度關係之區域差異分析‧建築與規劃學報，15(1)，61-82。[Chen, S. M., & Lin, P. S. (2009). The relationship between the living arrangement and life satisfaction of the elderly: A discussion of four regions in Taiwan. Architecture and Planning, 15(1), 61-82.]

陳美滿（2008）‧多種慢性病老年患者遵從醫囑服藥之障礙（未出版的碩士論文）‧臺南市：國立成功大學護理研究所。[Chen, M. M. (2008). The barriers to take medications as prescribed of elderly patients with multiple chronic diseases (Unpublished master’s thesis). Nursing Department of Medical College, National Cheng Kung University, Tainan City, Taiwan, ROC.]

American Heart Association. (2010). Heart disease and stroke statistics - 2015 update. A report from the American Heart Association. Rrtreived from http://circ.ahajournals.org/content/early/2014/12/18/CIR.0000000000000152.full.pdf

Albert, N. M. (2008). Improving medication adherence in chronic cardiovascular disease. Critical Care Nurse, 28(5), 54-65.