穴位措施對同步化放療頭頸癌病人疲憊與心率變異的改善成效

Effects of an Acupoint Intervention on Improving Fatigue and Heart Rate Variability in Head and Neck Cancer Patients Receiving Concurrent Chemoradiotherapy

背景：疲憊是頭頸癌病人於同步化放療期間最盛行的症狀，然而，穴位措施對頭頸癌病人之疲憊及心率變異效益仍未明確。目的：評值穴位措施對接受同步化放療的頭頸癌病人之疲憊及心率變異改善成效。方法：本隨機控制試驗研究採重複性測量，並以塊狀排列隨機分派病人至不同組別。穴位組與控制組的所有參與者均接受常規照護，穴位組再多接受六週體穴電刺激及耳穴貼壓。資料使用簡明疲憊量表及心率變異儀器收集，於前測、第1、2、3及6週進行測量。結果：廣義估計方程式分析的結果，呈現疲憊程度在介入措施第6週的組別與時間交互作用具有顯著差異（p＝.036），而正常心搏間期標準差、低頻功率、高頻功率及低頻／高頻功率比等心率變異參數均無組別與時間交互作用的顯著差異（p＞.05）。結論／實務應用：本研究支持穴位措施之可近性與可行性。此六週的體穴電刺激及耳穴貼壓措施，可用以改善接受化放療的頭頸癌病人的疲憊狀態，且未發現不良反應。 Background: Fatigue is the most common symptom in head and neck cancer patients who receive concurrent chemoradiotherapy (CCRT). However, evidence of the effects of acupoint interventions on fatigue and heart rate variability in these patients is unclear. Purpose: To evaluate the effect of an acupoint intervention on fatigue and heart rate variability in head and neck cancer patients receiving CCRT. Methods: This randomized controlled trail applied repeated measures, and used permuted block randomization to randomly assign the participants into the acupoint and control groups. Participants in both groups received usual care. In addition, participants in the acupoint group received transcutaneous electrical acupoint stimulation and auricular acupressure for a period of six weeks. Data were collected using the brief fatigue inventory and a heart rate variability device at baseline and during the 1^(st), 2^(nd), 3^(rd), and 6^(th) weeks of the study. Results: The generalized estimating equation analysis found a significant group-by-time interaction for fatigue on the 6^(th) week of acupoint stimulation (p = .036). No significant differences in group-by-time interaction were found for the standard deviation of normal to normal intervals (SDNN), low frequency (LF), high frequency (HF), or LF/HF ratio (p ＞ .05). Conclusions/Implications for Practice: This study supports the accessibility and feasibility of the acupoint intervention. No adverse effects were observed. The six-week transcutaneous electrical acupoint stimulation and auricular acupressure may be used to improve fatigue in head and neck cancer patients currently receiving CCRT.