癲癇病童與非癲癇兒童的頭痛症狀對其生活品質與學習適應影響之探討

The impact of headache on health-related quality of life and learning adaptation on children with epilepsy and non-epilepsy

鍾佩欣(Pei-Hsin Chung)

指導教授 ： 陳月枝

國立臺灣大學/醫學院/護理學研究所/碩士(2004年)

https://doi.org/10.6342/NTU.2004.01208

摘要

本研究是採描述相關性研究設計，來探討癲癇病童與非癲癇兒童的頭痛症狀對於其生活品質與學習適應的影響；以立意取樣的方式，於北部某醫學中心兒童神經內科門診，收取癲癇病童40位及非癲癇兒童40位，分成頭痛癲癇組20位、無頭痛癲癇組20位、頭痛組20位與健康組20位。在門診收取符合收案條件之個案給予生活品質及學習適應之問卷填寫，同時邀請癲癇病童之同儕一同參與研究。本研究目的為瞭解癲癇兒童與非癲癇學童的頭痛症狀對其生活品質與學習適應的影響程度；並進一步探討生活品質與學習適應的關係與預測因子，以做為學校護理人員護理及輔導老師輔導內容之參考。研究者於癲癇病童於門診或家中填寫完問卷後，再由其同儕填寫問卷，最後結果以統計套裝軟體SPSS 10.0 for Windows，進行描述與推論性統計分析。結果顯示：

一、癲癇組與非癲癇組的個人基本資料、癲癇狀況以及頭痛狀況無差異。
二、非癲癇組的生活品質比癲癇組的好；頭痛癲癇組的生活品質比無頭痛癲癇組生活品質好，健康組的生活品質比頭痛組為佳，而且在疼痛項目上呈顯著差異。
三、非癲癇組的學習適應比癲癇組的學習適應為佳，尤其是在身心適應方面呈顯著差異。頭痛癲癇組的學習適應比無頭痛癲癇組的學習適應為佳，健康組與頭痛組之學習適應情形無差異。
四、合併頭痛之癲癇病童與頭痛兒童在生活品質方面，頭痛組生活品質較頭痛癲癇組佳但未達統計上顯著差異。另外在學習適應方面，頭痛組的學習適應情況比頭痛癲癇組佳，亦未達統計上顯著差異。
五、在影響合併頭痛之癲癇病童與頭痛兒童的生活品質與學習適應的因素中，生活品質方面，性別、年齡、頭部外傷、癲癇藥物副作用、癲癇藥物數目、頭痛持續時間、上課的影響、伴隨症狀、減輕措施、先兆有無都會影響合併頭痛之癲癇病童與頭痛病童的生活品質；另外在學習適應的影響因素方面：性別、頭痛開始時間、頭痛程度、頭痛持續時間、頭部外傷、上課影響與下課影響、減輕措施、家族史等因素都是影響合併頭痛之癲癇病童與頭痛兒童學習適應情形的因素。
六、合併頭痛之癲癇病童其生活品質預測因子為上課受到中度影響，可解釋的變異量為21.3％，頭痛兒童生活品質的預測因子為國小以前開始頭痛與伴隨症狀，其解釋之變異量為45.2％。合併頭痛之癲癇病童學習適應的影響因子為上課不受頭痛影響、頭痛家族史與個人能力，其可解釋之變異量為89.8％，另外頭痛兒童之學習適應預測因子為輕度頭痛與個人能力，可解釋變異量為77.6％。
七、生活品質與學習適應呈現統計上中度正相關，所以當生活品質好的時候，其學習適應情況也會比較好。

本研究有助於瞭解頭痛對於癲癇病童與非癲癇兒童生活品質與學習適應影響情形的瞭解；並且可作為照護癲癇兒童與頭痛兒童的參考，最後可以提供護理教育、醫學團隊以及學校輔導老師在提供相關照護服務時的參考。

關鍵字

生活品質 ； 學習適應 ； 癲癇兒童

並列摘要

This research was designed to investigate the impact of headache on health- related quality of life and learning adaptation of children with epilepsy and non-epilepsy. A cross-sectional design with purposeful sampling was used in this study. The sample included 40 children with epilepsy and 40 children without epilepsy. Among the 20 children with epilepsy, 20 suffer from a history of headaches were chosen from pediatric neurology department of medical centers in Taipei. In non-epilepsy group, 20 of the 40 children suffered from a history of headaches was recruited from epilepsy children’s class. The purpose of this research is to find out headache affecting epilepsy and non-epilepsy children with headache and then to confer the relationship and find out the predict factors of quality of life and learning adaptation. SPSS for Windows 10.0 was used for both descriptive and influential statistical analysis.
No significant differences were found between the epilepsy and non-epilepsy children in terms of demographics. Among the children who have epilepsy, no significant difference was found between children with headaches and without headaches in terms of severity of seizure.
The result showed that children without epilepsy experienced significantly higher HRQOL than those with epilepsy. Among children who suffered from epilepsy, those who were headaches free showed significantly higher HRQOL than those who suffer from a history of headaches. Among non-epilepsy children who didn’t have headache history experienced significantly higher QOL especial in pain score than children who suffered from headaches.
With respect to learning adaptation, children without epilepsy experienced significantly higher than epilepsy group in physiological and psychological adaptation and overall score. As compared epilepsy children with and without history of headaches, epilepsy children without history experienced better learning adaptation. There were no significantly differences between non-epilepsy children with and without headache history in learning adaptation. Among children whom had headache history showed higher HRQOL and learning adaptation than those who suffer epilepsy with a history of headache. But there were no significantly differences.
The influence factors of the epilepsy and non-epilepsy children with headache history in quality of life are gender, age, history of headache injury, duration of headache, impairments and number of medications, the influence in school, combining symptom, interventions, and aura. The influence factors of the epilepsy and non-epilepsy children with headache history in learning adaptation are gender, the headache of onset, the level of headache, history of headache injury, duration of headache, the influence in and off school, intervention, family history of headache, and aura.
On the one hand, the predictor of QOL in epilepsy with headache history children is the medium degree influence in school and that can predict 21.3% of the total differences in the scores. The predictors of OQL in non-epilepsy with headache history children are the beginning before elementary school of headache and with symptoms, which can predict 45.2 % of the total differences in the scores. On the other, the predictors of learning adaptation in epilepsy with headache history children are without influence in school, family history with headache and personal competence that can predict 89.8 % of the total differences in the scores. Moreover, personal competence, mild level of headache can be the predictor factors of non-epilepsy children with headache history and that can predict 77.6 % of the total differences in the scores.
The result showed a high level of positive relationship between children’s quality of life and learning adaptation. In other words, children who experienced higher quality of life appeared to have higher level of learning adaptation.
The results of this study would contribute to the understating of the impact of headache on health-related quality of life and learning adaptation on children with epilepsy and non-epilepsy. The results would also be served as information resources for families with epileptic children, school nurse and their teachers.

並列關鍵字

epileptic children ； learning adaptation ； quality of life

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