重症肌無力症患者壓力源、社會支持及復原力

Stressor, Social Support and Resilience in Patients with Myasthenia Gravis

肌無力症是慢性病，患者因起伏肌肉無力症狀，影響生理、心理及社會功能及承受壓力，然而患者壓力因應及復原力結果卻有所差異。本研究採橫斷性設計，以方便取樣方式選定臺北市某醫學中心為研究場所，以神經科門診或住院確診為肌無力症患者為研究對象，收案為2017年5月1日至8月5日，有效問卷計150份。資料蒐集以結構式問卷，以統計軟體SPSS 21.0進行雙變項分析、相關性分析及階層迴歸分析，檢視社會支持在緩衝壓力源對復原力負向衝擊的作用。研究結果發現，階層迴歸分析結果顯示在控制基本人口特性與疾病特性變項下，壓力源與非正式及正式社會支持（家人、醫療人員、病友團體關懷幹部）對於復原力總變異量解釋力分別為45.9％、48.5％、45.7％，壓力源與非正式及正式社會支持對於復原力主要作用皆達顯著，但社會支持具有緩衝壓力源對於復原力負向衝擊作用未能得到印證。本研究結果可提供臨床醫療人員做為肌無力症醫療照護參考，協助肌無力症患者正向適應疾病而提昇復原力，依研究結果對於實務面建議：（一）增強非正式及正式社會支持，協助肌無力症患者提昇復原力正向適應疾病；（二）提供肌無力症臨床醫療人員參考進行醫療照護規劃；（三）提供肌無力症患者與家屬參考，適時尋求協助。

Myasthenia gravis (MG), a chronic disease with fluctuating muscle weakness, significantly interferes patient’s physical status, mental status, activities of daily life and social participation. Based on the nature of disease, the patients and their families bear a lot of pressure in the face of the disease. However, the coping strategies and resilience varied among individuals. This is a cross-sectional and convenience sampling study. Data for this study were collected from patients diagnosed with myasthenia gravis and selected in the neurology clinic or hospitalized department in a medical center in Taipei. The study was conducted from May 1 to August 5, 2017.There are 150 valid questionnaires collected. In this study, statistical software SPSS 21.0 was used for statistical analysis. The buffer effect of social support on the negative impact of stressors on resilience was examined by bivariate analysis, Pearson product-moment correlation coefficient, and hierarchical regression analysis. The source of informal and formal social support (family, medical staff, caring cadres of support group) could be explained by the total variation of resilience in 45.9%, 48.5% and 45.7%, respectively. The direct effect of stressors and social support (family, medical staff and patient care cadres) on resilience is significant. However, the buffer effect of social support on the negative impact of stressors on resilience has not been confirmed. The results of this study can provide clinical research and medical staffs as a reference for the medical care of myasthenia gravis, assist patients with myasthenia gravis to adapt to the disease and enhance resilience. Practical advices derived from the results of the study including the followings：First, enhance informal and formal social support to assist patients with myasthenia gravis to enhance resilience and to adapt positively to the disease. Second, provide clinical reference for medical care planning to patients with myasthenia gravis. Third, provide patients with myasthenia and their families to ask for assistance timely for reference.