黃秀梨臺灣大學：護理學研究所陳宏梅Chen, Hung-MeiHung-MeiChen2007-11-272018-07-072007-11-272018-07-072006http://ntur.lib.ntu.edu.tw//handle/246246/55766本研究目的在探討慢性C型肝炎患者接受干擾素合併Ribavirin治療相關因素。自2004年7月至2005年4月以立意取樣方式，於台北市某醫學中心門診選取33位18歲以上罹患慢性C型肝炎患者作為研究樣本，並採結構式問卷量表進行調查。研究工具內容包括：生活品質量表、自我效能量表、治療遵從行為量表、社會支持量表、身體症狀量表、情緒狀態量表及個人基本資料。患者一共接受五次問卷填答 (治療前T0、治療後兩週T1、一個月T2、兩個月T3、三個月T4)。研究資料以SPSS 12.0視窗套裝軟體進行描述性統計、重複測量單因子變異數分析、克-瓦單因子變異數分析、皮爾遜積差相關等統計方法分析。 本研究對象女性17人，男性16人，平均年齡50歲，C型肝炎病毒基因型以1b居多，肝纖維化程度以F2居多。研究發現，大部分慢性C型肝炎患者能按照醫師指定的時間及劑量使用藥物，但也會因為某些原因自行調整使用藥物的時間。在治療前三個月，計算Ribavirin平均口服劑量遵從率為93.99%，干擾素平均注射劑量遵從率達95.86%、接受治療時間的遵從率則為99.53%，回診率達100%，大部分的慢性C型肝炎患者均有較高的治療遵從行為。 慢性C型肝炎患者在接受干擾素合併Ribavirin治療前三個月時，實驗室檢查值除Seg在治療第二週先下降再緩慢增加外，其他項目ALT、AST、Total bilirubin、Cr、TSH及Free T4各數值均呈現逐漸下降情形。身體症狀在治療前三個月，常見類似感冒症狀，如：疲累、肌肉酸痛、失眠、頭痛、頭暈、關節痛等。情緒狀態在治療前三個月中疲憊-懶散之情緒次量表平均得分在治療前與治療後均排名第一，為負向情緒中最常出現症狀。 慢性C型肝炎患者接受干擾素合併Ribavirin治療在前三個月有中等程度以上的生活品質。社會關係範疇與環境範疇在治療前後較無明顯差異，心理範疇在治療前三個月一直為得分最低。社會支持在治療前三個月以情緒性支持最強，實質性支持最弱。支持來源部分以家人親戚朋友及配偶所獲得支持最多，從病友團體獲得支持最少。自我效能在治療前三個月時不因藥物副作用造成身體及情緒的不適，其自我效能平均得分仍高。 本研究結果有助於護理人員瞭解慢性C型肝炎患者接受干擾素合併Ribavirin治療情形及影響治療之相關因素，可作為提供整體性護理照顧的參考。The major purpose of this research was to examine the relationship between prescription adherence and its related factors among chronic hepatitis C patients who received regimen of interferon and ribavirin. Thirty-three chronic hepatitis C patients aged over 18 years were recruited through purposive sampling from one teaching hospital which is located in a metropolitan area of north Taiwan between July 2004 to April 2005. The structured instruments were applied and the participants were asked to complete Physical Symptoms Scale, Mood States Scale, Self-efficacy Scale, Social Support Scale, Quality of Life Scale, Treatment Adherence Scale and the Demographic Profile. All participants who completed the questionnaire at baseline (T0) were interviewed again at two weeks (T1) one month (T2), two months (T3), and three months (T4) after baseline (T0). Data entry and analyses were performed in SPSS 12.0. Descriptive statistics, repeated measure ANOVA, Kruskal-wallis test, Pearson’s product-moment correlation were used for the data analyses. The research sample in the study included 17 females and 16 males with an average age of 50 years. The majority of the genotype of hepatitis C virus is 1b and the degree of liver fibrosis is F2. The research found that the majority of chronic hepatitis C patients were able to take medication according to the timing and dosage prescribed by doctors. However, some patients changed the medication time for themselves due to personal reasons. In the first three months of the medication, the adherence rate of average oral dosage of ribavirin was calculated to be 93.99%, the adherence rate of average interferon injection dosage to be 95.86%, the adherence rate of medication timing to be 99.53%, clinic follow-up rate to be 100%, and most of chronic hepatitis C patients have relatively high medication adherence rate. In the first three months of the medication of chronic hepatitis C with interferon and ribavirin, the experimental values, except for Seg values which displayed an initial decrease and a subsequent increase during the second week of the medication, including ALT, AST, total bilirubin, Cr, TSH and Free T4, all values showed gradual decrease. Flu-like symptoms for example, fatigue, muscular pain, insomnia, headache, dizziness, and joint pain, were commonly seen during the first three months. Fatigue was the most common negative mood symptom in this sample. The average intensity scores of fatigue-inertia subscale of the Mood States Scale were highly ranked in the first one both before and after the medication. Chronic hepatitis C patients receiving medication of interferon and ribavirin reported fair quality of life in the first three months of medication. There was no significant difference in scores of the social relationships domain and the environment domain between before and after the medication. The psychological domain remained the lowest score during the first three months of the medication. According to results from the Social Support Scale, patients reported the highest scores on emotional support and the lowest scores on the tangible support (social support subscale- emotional support, informational support, appraisal support, and tangible support). The majority of the support sources came from family members, relatives, friends and spouse, while the least came from patient group. Although mild physical and emotional symptoms resulting from the adverse effect of the medicine made patients feel distress, the scores of the self-efficacy on treatment adherence remained high during the three months of the medication. Findings from this research can help health professionals and contribute significantly to the literature on the prescription adherence and its related factors among chronic hepatitis C patients who receive medication of Interferon and Ribavirin. This research provides abundant information which can serve as a reference for holistic nursing care.致謝-----------------------------------------------------------------------------------------Ⅰ 中文摘要-----------------------------------------------------------------------------------Ⅲ 英文摘要-----------------------------------------------------------------------------------Ⅴ 內容目錄-----------------------------------------------------------------------------------Ⅶ 圖表目錄---------------------------------------------------------------------------------- XI 第一章 緒論 第一節 研究動機--------------------------------------------------------01 第二節 研究目的--------------------------------------------------------04 第三節 研究問題--------------------------------------------------------05 第二章 文獻探討 第一節 慢性C型肝炎特性--------------------------------------------06 第二節 干擾素合併Ribavirin治療-----------------------------------08 第三節 治療遵從行為--------------------------------------------------10 第四節 影響治療遵從行為相關因素--------------------------------13 第三章 研究架構 第一節 研究概念架構--------------------------------------------------23 第二節 名詞界定及操作性定義--------------------------------------24 第三節 研究假設--------------------------------------------------------27 第四章 研究方法 第一節 研究設計--------------------------------------------------------28 第二節 研究對象與場所-----------------------------------------------29 第三節 研究工具--------------------------------------------------------31 第四節 研究工具信度與效度檢定-----------------------------------40 第五節 資料統計與分析-----------------------------------------------41 第六節 倫理考量--------------------------------------------------------42 第五章 研究結果 第一節 慢性C型肝炎患者接受干擾素合併Ribavirin治療前後之治療遵從行為-----------------------------------------------43 第二節 慢性C型肝炎患者基本資料--------------------------------47 第三節 慢性C型肝炎患者接受干擾素合併Ribavirin治療三個月內之身體症狀-----------------------------------------------52 第四節 慢性C型肝炎患者接受干擾素合併Ribavirin治療三個月內之情緒狀態-----------------------------------------------55 第五節 慢性C型肝炎患者接受干擾素合併Ribavirin治療三個月內之生活品質-----------------------------------------------58 第六節 慢性C型肝炎患者接受干擾素合併Ribavirin治療前後之社會支持-------------------------------------------------------------61 第七節 慢性C型肝炎患者接受干擾素合併Ribavirin治療前後之自我效能-----------------------------------------------------63 第八節 慢性C型肝炎患者接受干擾素合併Ribavirin治療前三個月各變項之相關性-----------------------------------------65 第六章 討論 第一節 慢性C型肝炎患者接受干擾素合併Ribavirin治療前三個月之重要因子與遵從行為關係-------------------------------68 第二節 慢性C型肝炎患者接受干擾素合併Ribavirin治療前三個月各變項因子間關係-------------------------------------------70 第七章 結論與建議 第一節 結論---------------------------------------------------------------75 第二節 護理上之應用---------------------------------------------------78 第三節 研究限制與建議------------------------------------------------80 參考資料 中文部分-------------------------------------------------------------------81 英文部分-------------------------------------------------------------------86 附錄 附錄一、專家效度名單--------------------------------------------------97 附錄二、接受干擾素合併Ribavirin治療記載專用表--------------98 附錄三、基本資料量表---------------------------------------------------99 附錄四、生活品質量表--------------------------------------------------100 附錄五、自我效能量表--------------------------------------------------103 附錄六、治療遵從行為量表--------------------------------------------104 附錄七、社會支持量表--------------------------------------------------105 附錄八、身體症狀量表--------------------------------------------------106 附錄九、簡式情緒狀態量表--------------------------------------------107 附錄十、藥物劑量計算表-----------------------------------------------108 附錄十一、治療週期表、門診回診率表------------------------------109 附錄十二、研究邀請說明-----------------------------------------------110 圖 表 目 錄 表1、各量表檢測時間表-----------------------------------------------------------------01 表2、各量表專家效度之平均得分和CVI值-----------------------------------------02 表3、前驅研究量表之內在一致性信度-----------------------------------------------03 表4、正式研究量表之內在一致性信度-----------------------------------------------04 表5、治療遵從行為量表各題平均得分與排序--------------------------------------05 表6、藥物劑量、治療時間與回診之遵從率------------------------------------------06 表7、研究對象之人口學資料-----------------------------------------------------------07 表8、疾病特性及治療情形--------------------------------------------------------------10 表9、追蹤治療前三個月的實驗室檢查值--------------------------------------------11 表10、身體症狀各題嚴重程度平均得分與排序------------------------------------12 表11、情緒狀態各題嚴重程度平均得分與排序------------------------------------13 表12、生活品質量表得分---------------------------------------------------------------14 表13、生活品質各項目平均得分------------------------------------------------------15 表14、C型肝患者整體評價自己的生活品質----------------------------------------16 表15、C型肝患者健康之整體滿意程度----------------------------------------------17 表16、C型肝患者接受治療之生活品質綜合自我評估----------------------------18 表17、C型肝患者接受治療之社會支持----------------------------------------------19 表18、自我效能量表各題平均得分與排序------------------------------------------20 表19、C型肝炎患者人口學變項對治療遵從行為影響----------------------------21 表20、C型肝炎患者治療前各變項之間相關----------------------------------------23 表21、C型肝炎患者治療第一個月各變項之間相關-------------------------------24 表22、C型肝炎患者治療第二個月各變項之間相關-------------------------------25 表23、C型肝炎患者治療第三個月各變項之間相關-------------------------------26 表24、接受治療之C型肝炎患者與一般人、肝臟疾病患者在生活品質上平均得分之差異--------------------------------------------------------------------27 圖3、治療三個月內WBC平均值變化圖---------------------------------------------28 圖4、治療三個月內Hb平均值變化圖------------------------------------------------28 圖5、治療三個月內Seg平均值變化圖-----------------------------------------------29 圖6、治療三個月內PT平均值變化圖------------------------------------------------29 圖7、治療三個月內Platelet平均值變化圖-------------------------------------------30 圖8、治療三個月內ALT平均值變化圖----------------------------------------------30 圖9、治療三個月內AST平均值變化圖----------------------------------------------31 圖10、治療三個月內Total bilirubin平均值變化圖---------------------------------31 圖11、治療三個月內Cr平均值變化圖-----------------------------------------------32 圖12、治療三個月內身體症狀平均值變化圖---------------------------------------32 圖13、治療三個月內情緒狀態平均得分圖------------------------------------------33 圖14、生活品質之四大範疇在不同治療時間得分變化圖------------------------33720937 bytesapplication/pdfen-US慢性C型肝炎治療遵從行為身體症狀情緒狀態生活品質社會支持自我效能Chronic hepatitis Ctreatment adherence behaviorsphysical symptomsmood statesquality of lifesocial supportself-efficacy[SDGs]SDG3[SDGs]SDG11otherhttp://ntur.lib.ntu.edu.tw/bitstream/246246/55766/1/ntu-95-R90426007-1.pdf