呼吸鬆弛處置以減輕心臟手術後之疼痛及生理反應

Breathing Relaxation Therapy in Reducing Pain and physiological Responses after Cardiac Surgery

疼痛為心臟手術病患不可避免的問題，而其所引發的諸多生理反應，對手術復原有著一定程度的影響，因此心臟手術病人疼痛問題不僅是病人實際的困擾，如何協助個案減少疼痛及其所衍生問題，也是醫療上重要的挑戰與課題。隨著非藥物性疼痛處置發展，鬆弛訓練的效益近年來頗受重視與肯定，但國內相關研究，並不多件；然探討發展適用於國人且又有效的非藥物性疼痛處置，以提供護理人員執行相關處置參考，實為當務之急，研究目的在探討呼吸鬆弛處置改善心臟手術病患疼痛及生理反應的成效。研究採準實驗法，在一級醫學中心之心臟外科病房，以立意取樣法選取60位心臟手術患者，分為控制組與實驗組各30名。實驗組提供個案於手術前開始進行有關呼吸鬆弛的教導與練習，輔以錄製好的錄音帶，長約15分鐘，以覆蓋式耳機進行播放，前五分鐘與後十分鐘請個案平躺，共三十分鐘；控制組個案只接受一般性常規照護，無任何呼吸鬆弛處置介入。於個案自加護病房轉入術後病房起，一日兩次進行呼吸鬆弛處置，持續至手術後第五日。研究結果發現，呼吸鬆弛處力能有效減輕心臟受數患者術後的疼痛及降低舒張壓與提昇指溫。影響呼吸鬆弛處置成效之個人基本因素探討發現，受到年齡、性別、宗教信仰、心臟病診斷等個人特性影響。呼吸鬆弛處置的確為一單純有效，應為急性疼痛中除止痛藥物給予外，輔以非藥物減痛處置中一可行的處置方案。

Pain is an unavoidable problem for cardiac surgical patients, and it can induce many changes in physiology and affects the recovery from the surgery. With the development of non-pharmaceutical pain control, the effect of relaxation therapy in pain control was emphasized and confirmed in the recent years. However, the related studies were rarely found in Taiwan. It is an urgent necessity to find a non-pharmaceutical pain control, which can be effectively applied in our people by nursing staff. The purpose of this study was to find the effect of breathing relaxation therapy in reducing pain and physiological responses in cardiac surgical patients. This experimentation collected 60 cardiac surgical patients from the cardiac surgical ward of a medical center. There were 30 patients in experimental and control group, respectively. The patients in control group received only routine care without intervention of relaxation therapy. Before the operation, the patients in experimental group had trained and practiced of breathing relaxation, which was aided by 15 minutes of records through the earphone. After the patients were transferred from ICU to ordinary ward, the relaxation therapy was done twice a day until 5th post-operative day. The effect of relaxation therapy in reducing pain in cardiac surgical patients was evaluated in this study by the following parameters: level of pain, physiological responses (including heart rate, systolic pressure, diastolic pressure, mean arterial blood pressure, and digit temperature). The result of this study revealed that relaxation therapy could effectively reduce reduce pain and diastolic pressure and increase digital temperature. The relaxation therapy's effect were influenced by individual characteristics and therapeutic history, such as age, sex, status, religion, diagnosis of cardiac diseases. .As a whole breathing relaxation therapy is really a simple and effective non-pharmaceutical pain control treatment, and it is worth to be widely applied in the clinical practice.