探討血液透析病人身體症狀困擾、睡眠品質與生活品質之相關性

Explore the Correlation among the Physical Symptoms, Sleep Quality and Quality of Life in Hemodialysis Patients

10.53106/172674042023122201006

黃琳貴(Lin-Kuei Huang)；劉月敏(Yueh-Min Liu)；潘美卉(Mei-Hui Pan)

血液透析病人 ； 身體症狀困擾 ； 睡眠品質 ； 生活品質 ； hemodialysis patient ； physical symptom distress ； sleep quality ； quality of life

臺灣腎臟護理學會雜誌

22卷1期（2023 / 12 / 01）

69 - 81

繁體中文;英文

背景：血液透析病人有疲倦和睡眠困難等身體症狀困擾，會影響其日常生活與活動，導致生活品質低下。目的：探討血液透析病人身體症狀困擾、睡眠品質與生活品質之相關性。方法：採橫斷式調查，研究對象共114位，以某區域教學醫院之血液透析病人為對象，以身體症狀困擾量表、中文匹茲堡睡眠品質量表、台灣簡明版世界衛生組織生活品質結構式問卷收集資料，通過IRB審查，取得編號：CTH-109-3-5-059，並於110年1/16至110年2/20期間收案，資料以描述性及相關性統計分析。結果：研究對象共114位，血液透析病人身體症狀困擾依序前五名為睡眠困難、疲倦、便秘或腹瀉、皮膚癢、肌肉抽筋，且有43.8％的病人自覺睡眠品質不佳的情形，身體症狀困擾與睡眠品質呈中度正相關，與生活品質呈中度負相關，而睡眠品質與生活品質則達顯著中度負相關。結論與應用：結果顯示身體症狀困擾越多，睡眠品質越差，生活品質越低。建議臨床護理人員幫助改善病人的身體症狀，讓病人獲得更好的睡眠品質和生活品質。

Backgrounds: Hemodialysis patients suffer from physical symptoms such as fatigue and difficulty sleeping, which affect daily life and activities, resulting in low quality of life. Objective: The purpose of this study is to investigate the relationship among physical symptom distress, sleep quality, and quality of life in hemodialysis patients. Methods: A cross-sectional and correlational design was utilized in this study, and a total of 114 participants were collected by convenience sampling from the regional teaching hospital in Taiwan. The research instruments include the symptom distress scale, the Chinese edition of the Pittsburg Sleep Quality Index, and the Taiwan edition of the brief version of World Health Organization Quality of Life scale. The data collected through the questionnaire passed the IRB review and obtained the serial number: CTH-109-3-5-059, and the case was accepted during the period from January 16, 2010 to February 20, 2010. The data were analyzed by descriptive and correlation statistics. Results: The top five physical symptoms of hemodialysis patients were sleep difficulty, fatigue, constipation or diarrhea, itchy skin, and muscle cramps. 43.8% of hemodialysis patients had poor sleep quality. There was a positive correlation between sleep quality (r=.57, p<.01), and a negative correlation between physical symptoms and quality of life (r=-.56, p<.01), and a negative correlation between sleep quality and quality of life (r=-.49, p<.05).Conclusion and Application: The results show that the higher the physical symptoms, the worse the sleep quality, and the lower the quality of life. It is recommended that clinical medical staff help improve the patient's physical symptoms, so that patients can get better sleep quality and quality of life.

1. 柯宜汝,吳貞蓉,謝伶瑜(2019)。探討運動訓練對於血液透析病人肌肉力量與疲倦改善之成效。嘉基護理，19(2)，46-50。
   連結：
2. 許珊毓,黃心樹(2019)。健康促進教育團體改善透析病人憂鬱程度、希望感及生活品質的研究。護理雜誌，66(4)，29-39。
   連結：
3. 陳沛其,盧國城,李碧霞,苗迺芳(2020)。探討血液透析病患社會支持、自我照顧行為、生活品質現況及其影響因素。新臺北護理期刊，22(1)，33-46。
   連結：
4. Bossola M.,Di Stasio, E,Antocicco, M,Panico, L,Pepe, G.,Tazza, L(2015).Fatigue Is Associated with Increased Risk of Mortality in Patients on Chronic Hemodialysis.Nephron,130(2),113-118.
5. Bossola, M.,Di Stasio, E,Marzetti, E,De Lorenzis, K,Pepe, G.,Vulpio, C.(2018).Fatigue is associated with high prevalence and severity of physical and emotional symptoms in patients on chronic hemodialysis.International Urology and Nephrology,50(7),1341-1346.
6. Buysse, D. J.,Reynolds III, C. F.,Monk, T. H.,Berman, S. R.,Kupfer, D. J.(1989).The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research.Psychiatry research,28(2),193-213.
7. Chiou, C. P.(1998).Development and psychometric assessment of the Physical Symptom Distress Scale.Journal of pain and symptom management,16(2),87-95.
8. Cleary, J.,Drennan, J.(2005).Quality of life of patients on haemodialysis for end-stage renal disease.Journal of advanced nursing,51(6),577-586.
9. Delmas, P.,Cohen, C.,Loiselle, M. C.,Antonini, M.,Pasquier, J.,Burnier, M.(2018).Symptoms and quality of life from patients undergoing hemodialysis in Switzerland.Clinical nursing studies,6(2),63-72.
10. Erdogan, A.,Dervisoglu, E.,Kutlu, A.(2012).Sleep quality and its correlates in patients on continuous ambulatory peritoneal dialysis.Scandinavian journal of urology and nephrology,46(6),441-447.
11. Flythe, J. E.,Hilliard, T.,Lumby, E.,Castillo, G.,Orazi, J.,Abdel-Rahman, E. M.,Pai ,A. B.,Rivara, M. B.,St Peter, W. L.,Weisbord, S. D.,Wilkie, C. M.,Mehrotra, R.(2019).Fostering Innovation in Symptom Management among Hemodialysis Patients: Paths Forward for Insomnia, Muscle Cramps, and Fatigue.Clinical Journal of the American Society of Nephrology,14(1),150-160.
12. Gerasimoula, K.,Lefkothea, L.,Maria, L.,Victoria, A.,Paraskevi, T.,Maria, P.(2015).Quality of life in hemodialysis patients.Mater Sociomed,27(5),305-309.
13. Hanly, P.(2008).Sleep disorders and endstage renal disease.Curr Opin Pulm Med,14(6),543-550.
14. Joshwa, B.,Campbell, M. L.(2017).Fatigue in Patients with Chronic Kidney Disease: Evidence and Measures.Nephrology Nursing Journal,44(4)
15. Kimmel, P. L.,Patel, S. S.(2006).Quality of life in patients with chronic kidney disease: focus on end-stage renal disease treated with hemodialysis.Seminars in nephrology,26(1),68-79.
16. Lenz, E. R.,Pugh, L. C.,Milligan, R. A.,Gift, A.,Suppe, F.(1997).The middle-range theory of unpleasant symptoms: an update.Advances in nursing science,19(3),14-27.
17. Mirghaed, MT,Sepehrian, R.,Rakhshan, A.,Gorji, H.(2019).Sleep Quality in Iranian Hemodialysis Patients: A Systematic Review and Meta-analysis.Iranian journal of Midwifery,24(6),403-409.
18. Muz, G.,Erdoğan Yüce, G,Yıldırım, C.(2021).The effect of sleep hygiene training applied to hemodialysis patients on sleep quality and quality of life: randomized controlled trial.Sleep and Biological Rhythms,19,227-236.
19. Parvan, K.(2013).Quality of sleep and its relationship to quality of life in hemodialysis patients.Journal of caring sciences,2(4),295.
20. Sabry, A. A.,Abo-Zenah, H.,Wafa, E.,Mahmoud, K.,El-Dahshan, K.,Hassan, A.,Okasha, K.(2010).Sleep disorders in hemodialysis patients.Saudi journal of kidney diseases and transplantation,21(2),300.
21. Saran, R.,Robinson, B.,Abbott, K. C.,Agodoa, L. Y.,Albertus, P.,Ayanian, J.,Shahinian, V.(2017).US renal data system 2016 annual data report: epidemiology of kidney disease in the United States.American journal of kidney diseases,69(3),A7-A8.
22. Tsai, P. S.,Wang, S. Y.,Wang, M. Y.,Su, C. T.,Yang, T. T.,Huang, C. J.,Fang, S. C.(2005).Psychometric evaluation of the Chinese version of the Pittsburgh Sleep Quality Index (CPSQI) in primary insomnia and control subjects.Quality of Life Research,14(8),1943-1952.
23. Wang, R.,Tang, C.,Chen, X.,Zhu, C.,Feng, W.,Li, P.,Lu, C.(2016).Poor sleep and reduced quality of life were associated with symptom distress in patients receiving maintenance hemodialysis.Health and quality of life outcomes,14(1),125.
24. Weisberg, S. D.,Fried, L. F.,Arnold, R. M.,Fine, M. J.,Levenson, D. J.,Peterson, R. A.,Switzer, G. E.(2005).Prevalence, severity, and importance of physical and emotional symptoms in chronic hemodialysis patients.Journal of the American Society of Nephrology,16(8),2487-2494.
25. Weisbord, S. D.,Fried, L. F.,Arnold, R. M.,Rotondi, A. J.,Fine, M. J.,Levenson, D. J.,Switzer, G. E.(2004).Development of a symptom assessment instrument for chronic hemodialysis patients: the Dialysis Symptom Index.Journal of pain and symptom management,27(3),226-240.
26. Yong, D.,Kwok, A.,Wong, D.,Suen, M.,Chen, W. T.,Tse, D.(2009).Symptom burden and quality of life in end-stage renal disease: A study of 179 patients on dialysis and palliative care.Palliative Medicine,23(2),111-119.
27. 田志宏,李文欽,許莉美,陳燕蘭(2016)。末期腎臟病患的睡眠障礙之發生以及腎臟替代療法對其影響。腎臟與透析，28(4)，180-184。
28. 白玉玲,洪士元,李碧娥,賴柳元,丘周萍(2015)。血液透析患者疲憊的評估與處置。腎臟與透析，27(1)，43-47。
29. 行政院衛生署（2020）．108年國人十大死因．取自https://www.mohw.gov.tw/cp-16-54482-1.html
30. 吳紅蓮(2017)。透析病人改善營養不良的重要性－營養諮詢與營養介入之應用。腎臟與透析，29(1)，49-53。
31. 李文欽,田志宏,許莉美(2019)。紅血球生成刺激劑在慢性腎臟病貧血治療的角色。腎臟與透析，31(4)，171-174。
32. 李偵碧,黃采薇,吳麗芬,陳夏蓮(2013)。長期血液透析病患健康生活品質相關因素之探討。護理暨健康照護研究，9(3)，173-181。
33. 李麗珠,郭碧照,孫閫範,陳芳真(2003)。中部某醫學中心血液透析患者皮膚搔癢及處置之探討。中山醫學雜誌，14(4)，523-531。
34. 姚開屏(2002)。台灣版世界衛生組織生活品質問卷之發展與應用。台灣醫學，6(2)，193-200。
35. 柯豐誠,李碧娥,施惠慈(2007)。長期洗腎病患的主觀生活品質－質性研究觀點。護理雜誌，54(1)，53-61。
36. 財團法人國家衛生研究院&台灣腎臟醫學會（2020）．2019年台灣腎病年報．取自https://www.tsn.org.tw/UI/L/TWRD/ebook_2019％E5％B9％B4％E5％A0％B1.pdf
37. 馬麗卿,孫嘉玲,謝湘俐(2010)。血液透析病患之憂鬱狀態及生活品質滿意度相關性研究。台灣腎臟護理學會雜誌，9，1-15。
38. 鈕淑芬(2004)。透析病患之生活品質及其相關因素探討。臺灣腎臟護理學會雜誌，3(2)，88-101。
39. 楊謹芸(2020)。高雄，義守大學護理學系碩士班。
40. 葉淑琴,孫嘉玲,馬麗卿,林燕如,謝湘俐(2012)。不同分期慢性腎臟疾病患者憂鬱狀態及健康相關生活品質之研究。臺灣腎臟護理學會雜誌，11(3)，16-32。
41. 廖秋萍,蔣偉姣,陳淑娟(2006)。腹膜透析病患生活品質及其相關因素探討。臺灣腎臟護理學會雜誌，5(1)，22-39。
42. 劉冠宏,郭依婷,吳安邦(2016)。血液透析常見的併發症。腎臟與透析，28(4)，164-167。
43. 衛生福利部中央健保署（2020）．重大傷病證明實際有效發證數．取自https://dep.mohw.gov.tw/DOS/cp2891-33287-113.html
44. 盧素真,陳世宜,黃淑珍,蘇玲華(2010)。血液透析病患睡眠障礙、憂鬱程度及其生活品質的分析探討。護理暨健康照護研究，6(1)，33-43。
45. 盧惠敏(2018)。台北，國立台北護理健康大學。
46. 顏妙芬,林姿佳,楊文中(2011)。顏妙芬林姿佳楊文中（2011）。

1. (2024)。有無確診COVID-19之血液透析病人日常生活健康現況與家庭照顧者負荷關聯性研究。管理實務與理論研究，18(2)，44-55。