| 摘要: | 本研究目的在了解陰虛證癌症病患陰虛症狀的情形，及其與自律神經功能的相關性，進而探討影響患者存活率之影響因素。本研究為橫斷面及追蹤性的相關性研究設計，於中部某區域教學醫院以立意取樣，經43位陰虛證癌症患者簽署同意書後參與研究。研究工具包括：自擬之結構式陰虛症狀量表、Lab VIEWTM生理信號擷取與分析系統、ANSwatch腕式生理監測儀器及套用公式換算之基礎代謝率。資料編碼後，以SPSS12.0套裝軟體進行描述性統計、變異數分析、Pearson相關、t檢定、複迴歸分析及Kaplan-Meier模式分析。
研究結果：陰虛證癌症患者陰虛症狀出現頻率以心煩失眠(90.7%)，舌紅/少苔或無苔（86.0%）及口乾舌燥（69.8%）較多。陰虛症狀之心煩失眠嚴重度與Low frequency power（LF power）呈顯著負相關，頭暈與脈象嚴重度與LF power呈顯著正相關。視力模糊嚴重度與心跳速率呈顯著負相關，手掌或足心熱嚴重度與心跳速率為顯著正相關。陰虛症狀之耳鳴或聽力減退嚴重度則與Low frequency/ High frequency（LF/HF ratio）呈顯著正相關。基礎代謝率與陰虛症狀之手足心熱、夜間盜汗嚴重度呈顯著正相關，而與耳鳴或聽力減退嚴重度則為顯著負相關。陰虛證癌症患者之存活率受到研究起始點之心跳速率增加、LF power下降、Very low frequency power（VLF power）下降、舌淡少苔或無苔及基礎代謝率上升影響，可作為陰虛證癌症患者四個月存活率的預測指標。
本研究顯示，評估陰虛證的症狀與證候，可以幫助醫師及護理人員及早偵測到癌症病患之陰虛證與自律神經功能紊亂情形而提供適當的處理，這將提昇護理的照護品質與治療的效果。
Yin-deficiency (YD) is common seen in cancer patients under late stage. So far, it is not known whether the Yin-deficient symptoms (YDS) are related to ANS functions which include heart rate variability, basal metabolic rate and blood pressure. The aims of this study were to evaluate the distribution of YDS, to analyze its’ relationships with ANS functions, and to investigate whether YDS and ANS functions can predict the survival time in cancer patients with YD.
A cross sectional and follow-up study was conducted on cancer patients in a teaching hospital in middle Taiwan. Forty-three patients were involved after signature of informed consent. We used a structure questionnaire to evaluate the severities of YDS, and measured ANS function with an analysis system, namely Lab VIEWTM. We also measured blood pressure with a monitor, namely ANS Watch, and further calculated basal metabolic rate with a special formula. We coded the collected questionnaire material and performed Statistics with SPSS12.0 coverall software. Data were analyzed by descriptions analysis, ANOVA, Pearson’s correlation coefficients, t-test, multiple regression and Kaplan Meier methods.
The results revealed that, the most 3 frequent and severe symptoms/signs in cancer patients with YD were poor sleep with annoyance (90.7%) , less or non-coated tongue with or without redness (86.0%), and dry mouth (69.8%). LF power had a significantly negative correlation with the summated degree of poor sleep with annoyance had but significantly positive correlations with both dizziness and rapid- small pulse. Heart rate had a significantly negative correlation with blurring vision but a significantly positive correlation with hot over palm and sole. LF/HF ratio had a significantly positive correlation with tinnitus and hearing decrease. On the other hand, BMR had the significantly positive correlations with both the summated degree of hot over palm and sole and night sweating but a significantly negative correlation with tinnitus and hearing decrease. The analysis on the survival rates of subjects for 4 months revealed that, 5 parameters including increased heart rate, decreased LF power and VLF power, less or non- coated tongue without redness and increased basal metabolic rate can predict the survival rate.
Our study results also suggest that, the evaluation of Yin-deficient symptoms/signs can help medical doctors and nurses to early detect YD and imbalance of ANS in cancer patients and to make proper nursing management as soon as possible. This will increase the quality of nursing care and promote the therapeutic effect. |
