帕金森氏病患者之疲憊感及其相關因素探討

Fatigue and Related Factors in Patients with Parkinson's Disease

背景：疲憊感是帕金森氏病患者最常見的症狀之一，但在台灣相關的文獻較缺乏。目的：本研究目的在瞭解帕金森氏病患者之疲憊感及其相關因素。方法：採用橫斷式相關性研究設計，以立意取樣方式於北部某醫學中心，選取100位帕金森氏病患者；採皮爾森積差相關、獨立樣本t檢定、卡方檢定、單因子變異數分析、逐步複迴歸分析與邏輯斯迴歸分析等統計方法。結果：研究結果發現：帕金森氏病患中：(1)46%有疲憊感；(2)帕金森氏病的症狀、病程分級、每日服用L-dopa劑量、睡眠品質、憂鬱與疲憊感呈顯著正相關，但日常生活功能與疲憊感呈顯著負相關；(3)憂鬱是疲憊感的重要預測因子可解釋總變異量的45.0%；(4)有憂鬱傾向者產生疲憊感的機率是無疲憊感者的5.375倍。結論：帕金森氏病患者的疲憊感是常見但又常被忽略的問題，本研究顯示：帕金森氏病的症狀、病程分級、每日服用L-dopa劑量、睡眠品質、憂鬱、日常生活功能與疲憊感呈顯著相關性，臨床醫護人員宜將疲憊感列為帕金森氏病患者之常規性評估，以提昇帕金森氏病患者照護品質。

Background: While fatigue ranks as one of the most common symptoms of Parkinson's disease (PD), few studies on PD-related fatigue have been done in Taiwan.Purpose: The purpose of this study was to explore PD fatigue and fatigue-related factors.Methods: A descriptive and correlation study design was used. Using purposive sampling, we recruited 100 subjects from a medical center in northern Taiwan. Data were analyzed using Pearson product-moment correlation, independent t-test, chi-square test, one way ANOVA, multiple regression and logistic regression.Results: Results showed that: (1) about 46% of participants reported fatigue symptoms; (2) UPDRS (Unified Parkinson's Disease Rating Scale) total score, Hoehen and Yahr stage (H&Y), daily L-dopa dose (mg), quality of sleep and depression symptoms each correlated positively with level of fatigue. The Schwab and England score (SES) correlated negatively with level of fatigue; (3) depression inclination explained 45.0% of variance in fatigue among subjects; (4) depression inclination was a significant fatigue predictor (OR=5.357, 95% CI=2.27-12.65) among participants.Conclusion: Fatigue associated with PD is a common and under-appreciated problem. The present study confirms UPDRS total score, HYS, daily L-dopa dose (mg), quality of sleep, depression symptoms and SES to correlate positively with level of fatigue. Assessment of fatigue should be part of the routine evaluation procedures used with PD patients to promote healthcare quality.