白血病患者化學治療期間整體舒適變化及其相關因子探討

The exploration of comfort and related factors in patients with Leukemia during chemotherapy

尤文鈺(Wun-Yu You)

指導教授 ： 馬維芬

中國醫藥大學/健康照護學院/護理學系碩士班/碩士(2015年)

摘要

2012年統計顯示，白血病位列癌症致死之第十三名。白血病之化學治療引起之副作用包括疲倦、噁心嘔吐、食慾下降、睡眠型態改變，甚至因治療導致免疫功能低下，感染機會提高，致死率上升等，造成病人的整體舒適情況急遽下降。
將白血病患者自發病起至治療過程中所經歷之不適，歸類為生理及心理兩層面。在生理層面上，疲倦為最常見但卻最容易被忽略之不適主訴。對於病人而言，是一種整體且不間斷的消耗感。同時伴隨心理上的焦慮、憂鬱問題，在彼此相互影響、甚至惡性循環之下，造成病人在壓力調適上的困難，使整體舒適情況的惡化，最終影響病人的生活品質以及持續接受治療的意願和配合程度。
本研究採縱貫式研究，並以立意取樣，使用結構式問卷方式針對急性骨髓性白血病患者收集其於化學治療前1-3天、施打後第6-8天、第13-15天及第20-22天的整體舒適、症狀困擾、癌因性疲倦、焦慮及不確定感等五個變項之變化情形，利用IBM SPSS 22.0版統計軟體進行描述性統計、單因子變異數分析及皮爾森積差相關等方式分析。
研究結果發現白血病患者在化學治療期間各變項隨時間呈波動變化，整體舒適程度在化療前最高，隨著治療的進行下降，直到恢復期再逐步上升。焦慮及不確定感程度在化學治療前最高，其得分隨著治療的結束而漸趨下降，情緒狀態則相對提升。社交狀態受治療後保護性隔離之影響，造成原本活躍之社交行為被迫下降。生理功能、日常生活功能、癌因性疲倦及症狀困擾深受化療藥物的影響，在患者經歷全血球低下及潛在危險性感染的壓力下，生理及日常生活功能低落、疲倦程度上升及副作用的發生幾乎無可避免，需等到化療藥物代謝、全血球數值回升，這些變項才會逐步的回升。
本研究結果明顯觀察到白血病患者於化學治療期間各變項之變化，與各時期主要影響舒適程度之相關因子，研究結果可協助醫護人員更了解白血病患者於各時期之照護需求，以期提高病人治療期間之生活品質，達到更有效及更顯著之成果，並提供臨床衛生教育、未來醫療處置及相關學者研究之參考。

關鍵字

白血病 ； 化學治療 ； 舒適 ； 症狀困擾 ； 癌因性疲倦 ； 不確定感 ； 焦慮

並列摘要

The major disease to cause death in Taiwan is related to cancer. The chemotherapy is an inevitable choice for patients with cancer during treatment processes. However, a lot of serious side effects cannot be avoided in chemotherapy that great impact patients’ physical and psychological comfort status. Fatigue and pain of physical condition combining anxiety and emotional stress of psychological condition are negative interactions in change conform status for patients with cancers during chemotherapy processes. This negative interaction somehow even stop patients from continue receiving treatments. Therefore, this study was to explore the comfort status for patients with cancers during different stage of chemotherapy. Meanwhile, the study tried to understand what roles of anxiety, uncertainty, and cancer-related fatigue in comfort status for patients with cancer during different process of chemotherapy. The cross-section survey design with purposive sampling was used for this study. The data were collected in four different time points, including one week before patients receive chemotherapy, the first one week, the 2 week and the 3 week after patients receive chemotherapy. Six instruments were included to measure study variables: the personal file sheet, shortened General Comfort Questionnaire, Functional Assessment of cancer therapy- fatigue subscale, Mishel’s Uncertainty in Illness Scale, Chinese Mandarin version State-Trait Anxiety Inventory Y form, and Symptom distress scale. Some biological test results were collected from patients’ chart. The one way ANOVA and Person’s correlation coefficient were used to examine the relationships among variables.
The result showed that the comfort status kept floating during the whole period reported from patients with leukemia. Before treatment, the score of comfort scale was the highest, and it decreased till the second week, and then started to rise in the third week. The feeling of anxiety and uncertainty declined by time, otherwise the motional status enhanced during the recovery period. The social status reduced since the protective isolation started. Physical status, functional status cancer-related fatigue, and symptom distress were affected by chemotherapy directly and were unavoidable, so the curves begun to rise after the side effect and the whole blood cell count was improved.
The study outcomes presented the roles of anxiety, uncertainty, cancer-related fatigue and symptom distress in comfort status for patients with cancer during different process of chemotherapy. Clinical nurses may provide nursing care based on study outcomes to help patients increase comfort status during different difficult stages in chemotherapy process.

並列關鍵字

leukemia ； chemotherapy ； comfort ； symptom distress ； cancer-related fatigue ； uncertainty ； anxiety

參考文獻

朱淑齡（2007）•一位急性淋巴性白血病病患接受化學治療之護理經驗•長庚護理，18(4)，624-632。

蔡琇文、賴裕和、陳美伶、陳主智（2000）•癌症疼痛生理感覺特質與疾病不確定感關係之探討•護理研究，8(1)，59-70。

許淑蓮、黃秀梨（1996）• Mishel疾病不確定感量表之中文版測試•護理研究，4(1)，59-68。

連金延、陳淑慧、蔡佩嬪、陳康敏、謝雅宜、梁穎（2010）•首次接受化學治療乳癌婦女介入護理指導後不確定感、焦慮及自我照顧之成效探討•護理雜誌，57(6)，51-60。

楊惠玲、張秀能（2007）•子宮頸癌復發病患面臨不確定感之護理經驗•護理雜誌，54(4)。doi: 101-105. doi: 10.6224/JN.54.4.101