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  • 學位論文

骨盆底肌肉運動對老年良性前列腺增生手術後下尿路症狀改善之成效

The Effects of Pelvic Floor Muscular Exercise on the Lower Urinary Tract Symptoms of the Elderly Patients after Benign Prostate Hyperplasia Surgery

指導教授 : 張佳琪

摘要


本研究目的在探討良性前列腺增生老年病患對於經尿道前列腺切除術手術經由骨盆底肌肉運動介入後第十二週下尿路症狀的改善成效、生活品質滿意度的提升與否,以及探討下尿路症狀與生活品質滿意度之相關性。本研究採類實驗設計採隨機分配,以骨盆底肌肉運動介入之實驗組及接受常規治療的控制組。測量變項包括個案基本資料、國際前列腺症狀總分(International Prostate Symptom Score ; I-PSS)、最大尿流速(Maximal Flow Rate;Qmax)、尿餘量(Post-void residual;PVR)及SF-36生活品質(Short-Form-36 Health Survey;SF-36)等。選取共61位個案參與,最後第十二週完成問卷調查研究者實驗組32人、對照組29人;完成尿流速測試的個案實驗組21人,對照組22人。主要研究結果:以統計分析IPSS在不同組別或不同時間之間皆有顯著差異,實驗組IPSS比對照組低β=-4.490分(p<0.001),各時期的IPSS均較手術前低;將IPSS項目分為阻塞症狀及刺激症狀,阻塞症狀分數實驗組IPSS比對照組低β=0.231分(p<0.001),刺激症狀分數實驗組IPSS比對照組低β=0.086分(p<0.001),各時期的IPSS均比手術前低;IPSS各項「排尿不乾淨」、「頻尿」、「排尿費力」、「排尿無力」、「夜尿」、「IPSS排尿素質」等項目實驗組改善程度顯著高於對照組。手術後「最大尿流速」(z=1.936, p=0.03)及「平均尿流速」(z=2.183, p=0.017),實驗組尿流速顯著高於對照組;「尿餘量」及「排尿量」兩組間無顯著差異。骨盆底肌肉運動介入的實驗組十二週後生活品質八構面中除「生理功能」(z=0.839, p=0.2025)及「身體疼痛」(z=0.851, p=0.199)無統計上顯著差異外,「生理面向」、「心理面向」、「生理功能角色受限」、「一般健康」、「活力」、「社會功能」、「情緒角色受限」、「心理健康」等項目顯著高於對照組; IPSS與SF-36相關性在「生理角色受限」、「生理功能」及「身體疼痛」,未達統計上顯著差異。「生理面向」、「心理面向」、「一般健康」、「社會功能」、「情緒角色受限」、「心理健康」、「活力狀況」等皆呈現顯著相關。結論:病患經尿道前列腺切除手術後,接受骨盆底肌肉運動介入後可有效改善下尿路症狀,提升病患生活品質,儘早讓病患回到正常排尿生活。

並列摘要


The purpose of this study is to evaluate the effect of pelvic floor muscular exercise on lower urinary tract symptoms (LUTS) and quality of life (QoL) of elderly men receiving transurethral resection of prostate (TURP) for benign prostatic hyperperplasia (BPH). The design of this study is randomizing patients scheduled on TURP into experimental group and control group, with and without instructions on pelvic floor muscular exercise, respectively. We collected their baseline data and International Prostate Symptom Scores (IPSS), measured their maximal urinary flow rate (Qmax) and post-void residual urine (PVR), and surveyed with Short-Form 36 health questionnaire (SF-36) for quality of life evaluation at 12 weeks after surgery. Total 61 patients completed the study, 32 in the experimental group (with pelvic floor muscular exercise) and 29 in the control group (without pelvic floor muscular exercise). The IPSS of experimental group is significantly lower than control group at all times (β=-4.490, p<0.001); both obstructive scores (β =0.231, p<0.001) and irritative scores (β=0.086, p<0.001) are lower in the experimental group. All of the 5 components of IPSS showed the same trend. physical functioning(z=0.839, p=0.2025)and bodily pain(z=0.851, p=0.199)no significant differences. Improvement of Qmax(z=1.936, p=0.03) and average urinary flow(z=2.183, p=0.017) are both significantly higher in the experimental group; however, the PVR and voiding volume are similar in the two groups. In the SF-36 analysis, experimental group showed better outcome in 8 of the 10 components: physical component summary, role limitation due to physical problems, general health, vitality, social functioning, role limitation due to emotional problems, and mental health. By linear correlations, 7 of the 10 components are correlated with IPSS except role limitation due to physical problems, physical functioning, and bodily pain. In conclusion, pelvic floor muscular exercise can improve LUTS and QoL in patients receiving TURP.

參考文獻


Lu, J.F., Tseng, H.M., & Tsai, Y.J. (2003). Assessment of healthrelated quality of life in Taiwan (I): development and psychometric testing of SF-36 Taiwan version. Taiwan J Public Health, 22, 501-11.
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陳志碩(2009)•量性前列腺增生及下尿路正確的診斷與治療•台灣尿失禁防治協會臨床診療指引,3(4),99-103。
Wang, C. J. (2009). Surgical intervention for Male Lower Urinary Tract Symptoms with Benign Prostate Hyperplasia. Incont Pelvic Floor Dysfunct, 3(2), 41-47.

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