- 學位論文
探討腦中風急性後期照護生活品質之研究
Quality of Life Among Post-acute Care Stroke Patients
摘要
研究目的 腦中風已經成為全球第三大死因疾病，而台灣腦中風則位居國人十大死因第二位。隨著人口逐漸老化，腦中風是老年人肢體障礙的主要原因。腦中風患者也多半會留下輕重不等的後遺症，例如肢體癱瘓、行動不便、語言障礙、吞嚥困難等症狀。因此，本研究主要探討腦中風患者急性後期照護入院時及入院後的相關生活品質及影響因子。 研究方法 本研究為前瞻性研究，針對整體功能狀態(MRS)2-4級之病患以問卷方式進行資料蒐集，於2015年10月至2017年1月，選取南部某兩間醫學中心、兩間區域醫院及一間地區醫院之腦中風病患為研究樣本。病患分為PAC和Non-Pac組，兩組皆以整體功能狀態(MRS)、巴氏量表(Barthel index)、吞嚥進食功能(FOIS)、健康相關生活品質評估(EQ5D)、工具性日常生活功能(IADL)、姿勢控制平衡功能(BBS)、認知功能(MMSE)問卷做為生活品質之測量。追蹤時間點分別為入院時、入院後6週和入院後12週，三個時間點。研究工具採用廣義估計方程式(GEE)進行生活品質的趨勢分析。 研究結果 本研究樣本共用有368位，平均年齡為67歲(SD=12.48)，男性占57.90%。230位(62.5%)的病患BMI≧24；317位(86.10%)為缺血性腦中風；228位(62%)過去病史有高血壓；30位(8.2%)出院診斷有泌尿道感染。兩組病患在MRS、EQ5D和BBS皆達顯著差異； 年齡每增加一歲在MRS、BI、EQ5D、IADL、BBS和MMSE皆達顯著差異；出血性腦中風相較於缺血性在MRS、EQ5D和IADL皆達顯著差異。 結論與建議 該研究了解PAC和Non-PAC之腦中風患者在不同時間點的生活品質狀況。研究發現兩組病患在入院後雖然都有改善，但PAC組的改善幅度明顯高於Non-PAC組。雖然在有些問卷在12週反而Non-PAC組的病患狀況較好，但後續的狀況必須持續觀察和追蹤，才能更深入了解兩組病患的生活品質。
並列摘要
Objectives Stroke has become the world's third largest cause of death. Brain stroke in Taiwan is ranked number two among the top ten causes of death. With the aging of the population, stroke is the main cause physical disorders with the elderly. The sequela that follows a stroke is sever, such as limb paralysis, immobility, language disorders, dysphagia and other symptoms. Therefore, the purpose of this study is to research the quality of life and the factors of influence among stroke patients in admission and after admission. Methods This is a prospective study, which is focus on stroke patients in levels 2-4 of the Modified Rankin Scale (MRS). Questionnaire data was collected in southern medical center, two regions hospital and a district hospital. The research is from October 2015 to January 2017. The patients are in two groups, which is PAC group and Non-Pac group. The two groups of patients completed the Modified Rankin Scale (MRS), Barthel index (BI), Functional oral intake scale (FOIS), Euro QoL-5D (EQ5D), Lawton-Brody IADL Scale (IADL), Berg Balance Scale (BBS), Mini–mental state examination (MMSE) questionnaire as a measure of quality of life. All patients were examined at 6 weeks and 12 weeks after admission. The research tools use the generalized estimation equation (GEE) to analyze the quality of life. Results 368 patients were sampled in study. The average age was 67 (SD = 12.48). Males accounted for 57.90%. There were 230 patients (62.5%) with a BMI of 24. 317 (86.10%) had ischemic stroke; 228 (62%) had a history of hypertension; 30 (8.2%) were diagnosed with urinary tract infection. Two groups of patients were significant in MRS, BI, EQ5D, IADL, BBS and MMSE. There was significant increase in MRS、BI、IADL、BBS and MMSE when one year older. Hemorrhagic stroke compared with ischemic was significant in MRS, EQ5D and IADL. Discussion The study can further our understanding of the quality of life among PAC and Non-PAC stroke patients at different follow-up times. The study found that both patients had improved after admission, but the improvement in the PAC group was better than the Non-PAC group. Although the Non-PAC group after 12 weeks admission in some questionnaires was better, patients’ need continuous follow-up in order to understand the quality of life among two groups of patients in the future.
參考文獻
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