以縱貫式研究探討急性白血病患化學治療的經驗

The experience of receiving chemotherapy in acute leukemia patients - A longitudinal prospective

陳佩瑛(Chen Pey-ying)

指導教授 ： 賴裕和

臺北醫學大學/護理學院/護理學研究所/碩士(2005年)

摘要

本研究在探討急性白血病患其化學治療期間所經歷之症狀和經驗。採前瞻性縱貫式研究設計。於93年3月至93年11月間，以「症狀嚴重度評估表」、「醫院焦慮憂鬱量表」、「口腔黏膜評估表」、「身體功能評估表」等作為評估工具，並配合病患抽血檢驗數值，以北部某醫學中心之急性白血病患為對象，探討34位個案，以了解急性白血病患化學治療期間的完整經驗。研究顯示所有症狀發生的比例，以口乾為最高。症狀嚴重度以疲倦最為嚴重。某些症狀嚴重度會隨化學治療後時間不同而改變，三十四種症狀中，共有十五項症狀的症狀嚴重度改變達到統計上的顯著差異。在二十八天的觀察中，症狀嚴重度改變以疼痛、口腔黏膜炎、發燒與顫抖 / 忽冷忽熱等症狀與嗜中性球減少之間的關係是密切的。與身體心像有關的症狀，對部分病患是嚴重的，且在第三週後逐漸嚴重並且持續直至研究結束。化學治療期間焦慮與憂鬱的情形雖然隨測量時間不同而改變，但是在統計上並未達到顯著差異，病患的焦慮程度的平均得分介於4.32 - 5.24之間，憂鬱程度的平均得分介於6.26 - 7.59之間，焦慮的盛行率為5.8-11.7 %，憂鬱的盛行率為14.7-29.4 %。化學治療後第十至第十五天，白血球數低於1000/mm3;第十一至十六天持續嗜中性白血球低下。白血球數目、中性球數目、血色素值與血小板數目和症狀嚴重度平均值呈高度相關。腎功能與症狀嚴重度平均值間有相關，但肝功能則無相關。症狀嚴重度與焦慮憂鬱之間的相關，在第三週後始有相關。 本研究結果顯示急性白血病患的化學治療期間的症狀嚴重度、焦慮憂鬱情形與血液檢驗改變情況。將可提昇醫護人員對急性白血病患化學治療後的症狀嚴重度有具體的瞭解，並可做為未來照護此族群病患的參考與依據。

關鍵字

急性白血病患 ； 嗜中性白血球減少 ； 症狀嚴重度

並列摘要

The aim of this study is to investigate the symptoms and experiences of patients with leukemia receiving chemotherapy. This research method is a prospective and longitudinal evaluation. We use the ‘Symptom severity Scale’, ‘Hospital Anxiety and Depression Scale’, ‘Eastern Cooperative Oncology Group — Performance Status Scale’, ‘National Cancer Institute Toxicity Criteria — Oral Mucosa Assessment’ as the evaluation tool. Thirty-four patients with acute leukemia were collected from a medical center in northern Taiwan between 2004 March and November. Dry mouth is the most common symptom. Fatigue is the most severe symptom. Some symptom severity varied with time post chemotherapy. The change of symptom severity had statistical significance in fifteen of total thirty-four symptoms. Pain, mucositis, fever and chills were closely related to neutropenia in 4-week evaluation period. The symptoms associated with body image were important to some patient and the severity increased since the third week and lasted to the end of study. The severity variation of anxiety and depression is not statistical significance after chemotherapy. The anxiety score ranged from 4.32 - 5.24, the depression score ranged from 6.26 - 7.59. The prevalence of anxiety and depression are 5.8-11.7 % and 14.7-29.4 %. The leukocyte below 1000/mm3 is 10th day to 15th day post chemotherapy; neutropenia is noted between 11th day to 16th day. The leukocyte count, neutrophil count, hemoglobin level and platelet count are highly correlated to the mean symptom score. The renal function test is correlated to the mean symptom score but the liver function test is not. The anxiety and depression are correlated to the mean symptom score since the third week post chemotherapy. The result revealed the symptom severity, anxiety, depression and laboratory data in leukemic patients post chemotherapy. According to this data, it will provide further knowledge for nursing and medical treatment.

並列關鍵字

acute leukemia ； neutropenia ； symptom severity

參考文獻

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