臺灣博碩士論文加值系統

中文摘要
背景：
腦血管疾病病人中，約 23%至 50%會出現吞嚥困難。臨床上對吞嚥困難的評估不僅需進行生理檢查，亦需考量病人的心理健康狀態。有效的吞嚥評估和自我評估工具，透過臨床或居家自我檢測，有助於早期察覺高風險病人，藉此減少病情惡化及死亡風險。

目的：
本研究主旨在探討急性期腦中風病人的吞嚥困難、自我吞嚥評估與憂鬱之間的相關性。

方法：
本研究採橫斷性設計，針對台灣中部某醫學中心神經內科病房的急性缺血性腦中風病人，採用方便取樣方式收集 140位患者資料。使用Yale Swallow Protocol（YSP）進行吞嚥篩檢，並透過結構式問卷收集人口學資料，包含進食吞嚥困難檢測問卷（EAT-10）和病人健康問卷（PHQ-9）以評估病人的吞嚥狀況與憂鬱程度。資料分析採用SPSS 25.0進行描述性和推論性統計，並以卡方檢定與線性迴歸探討變項之間的相關性。
結果：經過YSP(吞嚥篩檢工具)篩檢後，吞嚥困難與腦中風嚴重程度呈顯著相關，腦中風嚴重程度越高的病人，其吞嚥困難的比例越高（χ² = 13.04, p = 0.02）。在吞嚥困難與憂鬱嚴的關聯性方面，雖有吞嚥困難者發生憂鬱的勝算比為無吞嚥困難者的2倍，但在統計學上未達顯著差異（β = .69, p <.16）。然而當病人出現吞嚥困難，有可能會加重憂鬱的程度。
經過吞嚥自我評估結果為，自覺吞嚥困難與憂鬱程度具有顯著關聯（β = 1.53, p < .000）。此外，吞嚥困難程度與憂鬱程度之間雖無顯著正相關，（β = .69 p <.16），但吞嚥困難的憂鬱勝算比仍為沒有吞嚥困難者的2倍，顯示吞嚥困難可能會導致憂鬱情形發生；而自我評估與憂鬱程度的正相關（β = 1.53, p < .000）則可說明為，自覺吞嚥困難的病人可能面臨更高的憂鬱風險。
結論：
病人的自我評估可作為早期發現吞嚥困難和相關心理健康問題的有效工具，進一步強調自我評估在臨床與日常照護中的潛在價值。

英文摘要
Background:
Among patients with cerebrovascular diseases, approximately 23% to 50% experience dysphagia. Clinical evaluation of dysphagia requires not only physiological assessments but also consideration of the patient’s psychological health. Effective swallowing evaluation and self-assessment tools, whether performed clinically or through self-monitoring at home, can aid in the early detection of high-risk patients, thereby reducing the risk of disease progression and mortality.

Objective:
This study aimed to investigate the relationship between dysphagia, Eating Self-Assessment Tool, and depression among patients with acute stroke.

Methods:
This cross-sectional study was conducted with 140 patients diagnosed with acute ischemic stroke from the neurology ward of a medical center in central Taiwan, recruited through convenience sampling. The Yale Swallow Protocol (YSP) was used for swallowing screening, and structured questionnaires were utilized to collect demographic data, including the Eating Assessment Tool (EAT-10) for swallowing difficulties and the Patient Health Questionnaire (PHQ-9) for depression assessment. Data analysis was performed using SPSS 25.0 with descriptive and inferential statistics, employing Chi-square tests and linear regression to explore the relationships between variables.

Results:
Dysphagia was significantly associated with stroke severity, with a higher proportion of patients experiencing dysphagia as stroke severity increased (χ² = 13.04, p = 0.02). Dysphagia was not significantly associated with the severity of depression (β = 0.69, p = 0.16), although patients with dysphagia had twice the odds of developing depression compared to those without dysphagia. However, the presence of dysphagia may contribute to increased depression severity.
The analysis of the correlation between the Eating Assessment Tool-10 (EAT-10) self-assessment of dysphagia and depression severity showed a significant association between perceived swallowing difficulty and depression severity (β = 1.53, p < .000). Additionally, although the severity of dysphagia was not significantly correlated with depression (β = .69, p < .16), the odds ratio for depression in patients with dysphagia was still twice as high as in those without dysphagia, suggesting that swallowing difficulties may contribute to the occurrence of depression. The significant positive correlation between self-assessed swallowing difficulty and depression severity (β = 1.53, p < .000) indicates that patients who perceive themselves as having swallowing difficulties may be at a higher risk of depression.

Conclusion:
There is no significant correlation between dysphagia severity and depression; however, perceived swallowing difficulty is significantly associated with depression. Additionally, self-assessment can serve as an effective tool for the early detection of swallowing difficulties and related mental health issues, further emphasizing its potential value in clinical and daily care settings.

目錄
謝誌 I
中文摘要 III
英文摘要 V
目錄 VII
表目錄 IX
圖目錄 X
第一章緒論 1
第一節 研究背景與動機 1
第二節 研究目的 3
第三節 研究問題 4
第四節 名詞定義 5
第二章文獻探討 7
第一節 腦中風病人吞嚥困難的機轉與原因 8
第二節 腦中風病人的吞嚥困難與身心壓力 13
第三節 腦中風病人吞嚥困難的評估 18
第三章研究方法 25
第一節 研究架構 25
第二節 研究設計與對象 26
第三節 研究工具 29
第四節 研究步驟 34
第五節 資料分析方法 35
第六節 研究倫理考量 36
第四章結果分析 38
第一節 病人之人口學特性 39
第二節 病人吞嚥困難與腦中風嚴重程度的相關性 41
第三節 病人吞嚥困難與憂鬱的相關性 42
第四節 病人自我評估與憂鬱的相關性 43
第五節 病人吞嚥困難、自我評估和憂鬱是否有相關 44
第五章討論 46
第一節 病人人口學特性、疾病嚴重度及憂鬱之分析 46
第二節 病人吞嚥困難與憂鬱的相關性 49
第三節 病人自我評估與憂鬱的相關性 50
第四節 病人吞嚥困難、自我評估和憂鬱是否有相關 52
第六章結論與限制 53
第一節 結論 54
第二節 研究限制 55
第三節 應用與建議 57
參考文獻 59
附錄 67
表目錄
表3- 6 統計方法 36
表4- 1- 1 腦中風病人之人口學特性（N＝140） 39-40
表4- 2- 1 吞嚥困難與腦中風嚴重程度 41
表4- 3- 1 吞嚥結果與憂鬱列聯表 42
表4- 4- 1 自我評估與憂鬱列聯表 43
表4- 5- 1 急性期腦中風病人吞嚥困難、自我評估和憂鬱之邏吉斯迴歸 44
表4- 5- 2 急性期腦中風病人與憂鬱的關係 45
圖目錄
圖3- 1 研究架構 25
圖3- 2- 1 G-power試算 27
圖3- 4- 2- 1 Yale Swallow protocol操作流程 30
圖3- 4- 2- 2 90c.c.喝水測試注意事項 31
圖3- 4- 2- 2 90c.c.喝水測試姿勢 31
圖3- 5- 1 收案流程 34

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