冠狀動脈繞道術後病人睡眠品質及相關因素探討

Sleep Quality and Related Factors in Patients after Coronary Artery Bypass Surgery

楊佩陵(Pei-Lin Yang)

指導教授 ： 羅美芳

國立臺灣大學/醫學院/護理學研究所/碩士(2011年)

https://doi.org/10.6342/NTU.2011.00862

摘要

睡眠品質不佳為冠狀動脈繞道術後常見之健康問題之一，本研究為描述性、相關性之調查研究設計，以立意取樣針對冠狀動脈繞道術後出院後一週及一個月返診病人，以結構式問卷進行睡眠品質及相關因素之探討。研究工具包括匹茲堡睡眠品質量表、疼痛10分量表、疲憊量表與醫院焦慮及憂鬱量表，共收案52人，所蒐集資料以SPSS/Window17.0套裝軟體進行描述性和推論性的統計分析，研究結果如下：
1. 出院後一週時，84.6%研究對象自覺有睡眠問題，根據匹茲堡睡眠品質量表得分，86.5%研究對象有睡眠品質不佳之情形；出院後一個月，73.1%研究對象自覺有睡眠問題，63.5%研究對象有睡眠品質不佳之情形。整體來看，出院後一個月和出院後一週相比，研究對象自覺有睡眠問題人數顯著減少且睡眠品質顯著改善。
2. 研究對象年齡越大、心臟功能越差、疲憊程度越高、焦慮程度越高及憂鬱程度越高者，其睡眠品質越差。「有婚姻伴侶者」比「無婚姻伴侶者」出院後一週之睡眠品質顯著較差。
3.「疲憊」及「焦慮」為研究對象出院後一週睡眠品質顯著預測因子，共可解釋睡眠品質31.8%的變異量；「憂鬱」及「焦慮」為研究對象出院後一個月睡眠品質顯著預測因子，共可解釋睡眠品質61.9%的變異量。
4. 本研究對象睡眠自我處理策略以採取「不理會」居多，「服用安眠藥」次之，約二成(17.4-19.2%)研究對象表示在自我嘗試錯誤後發展出其他睡眠處理策略。但研究對象大多認為睡眠自我處理策略無效，且資訊來源有限。
5. 睡眠問題普遍存在於冠狀動脈繞道術後病人，隨著研究對象之心臟功能、疲憊、焦慮及憂鬱情形改善，其睡眠品質也隨著改善，呈動態變化。
根據本研究結果，建議護理人員應主動評估冠狀動脈繞道術後病人有無睡眠問題，適時主動提供相關資訊，根據造成睡眠品質不佳之因素，提供合適睡眠處理策略。

關鍵字

冠狀動脈繞道手術 ； 睡眠品質 ； 疼痛 ； 疲憊 ； 焦慮 ； 憂鬱

並列摘要

Poor sleep quality is a common health problem after coronary artery bypass surgery. The aim of this study was to investigate sleep quality and related factors in patients after coronary artery bypass surgery. The design of this study was based on survey research, and the participants were patients who went back to the clinic for follow-up examinations after being discharged from hospitalization from one week to one month, among whom fifty-two patients were recruited. Structural questionnaires, including Pittsburgh Sleep Quality Index, 10 point pain scale, Fatigue Scale, Hospital Anxiety and Depression Scale were used to collect data. The data were analyzed by SPSS/Windows 17.0 software. The results of study were as follow:
1. At one week after being discharged, 84.6% of participants reported sleep problem and the prevalence of poor sleep quality in these participants was 86.5% on Pittsburgh Sleep Quality Index. At one month after being discharged, 73.1% of participants reported sleep problem and the prevalence of poor sleep quality in these participants was 63.5%. In general, the number of participants with sleep problem and the prevalence of poor sleep was significantly reduced from one week to one month post hospitalization.
2. Participants with older age, worse heart function, higher fatigue level, higher anxiety and depression level had poorer sleep quality. In addition, participants with bed partners had significantly poorer sleep quality than participants without bed partners at one week after being discharged.
3. “Fatigue” and “anxiety”were significant predictors of sleep quality and accounted for 31.8% of the total variance at one week after being discharged. ”Depression” and “anxiety”were significant predictors of sleep quality and accounted for 61.9% of the total variance at one month after being discharged.
4. The most frequently used strategy for sleeping problems was “to ignore” and the second one was “to take prescribed medicines”, only 17.4-19.2% of the participants used self-devised strategies to solve their sleeping problems. The result showed that strategies used by these participants were ineffective and their source of information was limited.
5. Sleep problems is common for patients who underwent coronary artery bypass surgery, and it is a dynamic process. With the improvement of their heart function, fatigue level, anxiety and depression level, their sleep quality can also improve as well.
According to the research findings, nurses are highly recommended to assess sleep after coronary artery bypass surgery and offer them appropriate sleep hygiene management strategies.

並列關鍵字

coronary artery bypass surgery ； sleep quality ； pain ； fatigue ； anxiety ； depression

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