耳穴按摩對肝膽術後病人疼痛與焦慮之成效

Efficacy of Auricular Acupressure for Relieving Pain and Anxiety of Patients Receiving Hepatobiliary Surgery

背景與目的：本研究在探討耳穴按摩對肝膽術後病人其疼痛與焦慮改善之成效。方法：採實驗性前- 後測設計，符合選案條件之病人且同意參與，隨機分派至實驗或控制組。對象為台灣北部某教學醫院外科病房，經專科醫師診斷為符合之病人。以Randomization Main電腦體進行簡單之隨機分派至實驗組與控制組，共有43 人參與研究，實驗組術後第一天至第七天分別接受每天三次，每次15 分鐘的耳穴按摩，控制組僅接受常規照護。以結構式問卷收集資料，包括：疼痛視覺類比量表、醫院焦慮量表、脈搏與血氧濃度監測、止痛藥物使用劑量等。所得資料以描述性統計及一般線性模式(General Linear Model，GLM) 分析。若交互作用項顯著，進一步使用 Johnson-Neyman 法估計其交點之95% 信賴區間，並推論其介入有效範圍。所有統計分析使用IBM SPSS ver 20.0 進行分析。結果：疼痛視覺類比量表在實驗組實施耳穴按摩介入後，組別與疼痛前測之交互作用在控制了止痛藥使用量後，達到統計顯著差異(p=0.002)，進一步使用Johnson-Neyman 法估計交點信賴區間為(88.082, 89.420)，代表肝膽術後病人，若其前測疼痛視覺得分在89.42 分以上者，若其接受耳穴按摩介入措施，其後測分數將會達到顯著改善。然而，實驗組與對照組在焦慮地改善上並未呈現顯著差異。結論：建議肝膽術後病人除常規的治療與照護外，可以輔以耳穴按摩，以達到疼痛減輕的效果。

Background and Purpose: This study investigated the efficacy of auricular acupressure for relieving pain and anxiety in patients receiving hepatobiliary surgery. Methods: This study adopted an experimental pre- and post-test design. A total of 43 participants who satisfied the inclusion criteria and agreed to participate in the study were randomly divided into an experimental group and a control group by using Randomization Main software. The experimental group received auricular acupressure three times(15 mins/time) per day for 1 week following surgery, and the control group received routine care. Pulse rates and oxygen saturation levels were monitored, and structural questionnaires were administered: the visual analogue scale (VAS) of pain, Intravenous Patient-Controlled Analgesia, and the Hospital Anxiety and Depression Scale. The data were presented using descriptive statistics and analyzed using a general linear model. If the interaction between a group and a pretest showed statistical significance, the Johnson- Neyman method was applied to estimate the 95% confidence interval of post-test efficacy. All data were analyzed using SPSS Version 20.0 software. Results: The interaction term between the VAS pretests of the groups showed statistically significant differences, and the Johnson-Neyman method was applied. The results showed that, when the pretest VAS score was greater than 89.42 points (p = 0.002), the experimental group showed a significantly lower score on the post-test than did the control group. However, the experimental and control groups did not show a significant difference for anxiety. Conclusions: In addition to conventional treatment, auricular acupressure is suggested for relieving pain and anxiety in patients receiving hepatobiliary surgery.