臺灣博碩士論文加值系統

本研究係以掌上型電動遊戲作為轉移注意力措施，探討白血病學齡患童接受腰椎穿刺時疼痛生理反應（心跳、收縮壓）的影響。採取交叉配對之實驗性研究設計，研究對象取自3所醫學中心，接受腰椎穿刺治療的白血病患童，以立意取樣選取11位學齡患童進行研究，每位患童都是實驗組亦為本身的控制組。其中以在腰椎穿刺時有電動遊戲做為轉移注意力措施的進行實驗組步驟，而沒有電動遊戲的進行控制組步驟，兩次測量時間間隔至少1星期以上。電動遊戲措施的時機為腰椎穿刺前2分鐘到穿刺結束後，患童自行結束遊戲，於穿刺前紀錄每分鐘心跳及每2分鐘血壓資料作為基準值，於穿刺當時及穿刺後紀錄心跳及血壓，以作為比較同一個患童接受電動遊戲對疼痛之生理指標的影響。採用之研究工具包括掌上型電動遊戲、生理測量儀器（Philips M1205A monitor）。
研究發現在疼痛之心跳速率方面：腰椎穿刺時的心跳比基準值時高。患童於接受電動遊戲時，其心跳變化在穿刺後回復至基準值的時間較快，且具統計意義（P＜0.01）；收縮壓方面：穿刺當時收縮壓比基準值高。患童接受電動遊戲時，其收縮壓雖於穿刺當時及穿刺後的改變量較未接受電動遊戲時之差異無顯著差異，但仍比無接受電動遊戲時，穿刺當時上升變化較少。
整體而言，以電動遊戲做為轉移注意力措施可穩定疼痛之生理反應。故企盼未來於臨床執行各項護理作業之際，能適時運用電動遊戲之轉移注意力措施，提供對需要多次接受穿刺治療患童的支持，轉移因侵入性治療引起的疼痛感受，進而提升臨床兒癌醫療護理品質及成效。

A cross-over experimental design was carried out to investigate pain physiological parameters with palm operated games as the distractor. Eleven school-aged children with leukemia, receiving lumbar punctures from the outpatient hematology-oncology clinic or in-patient oncology unit in three medical centers were selected to participate in this study. Before lumbar puncture, Philips M1205A monitor was used to collect subjects’ heart rate and systolic blood pressure as baseline data. The palm operated game was employed from 2 minutes before implementing the lumbar puncture till the finish of puncture and then subjects naturally removed game by themselves. During the lumbar puncture procedure, the same physiological parameters were recorded every minute to analyze the influence of palm operated game as the distractor.
Major findings of this study were as follows：1. The heart rate was higher than the baseline while puncture, and when the child received the palm operated game, the heart rate returned to baseline level was faster than that did not received（P＜0.01）.2. The systolic blood pressure was higher than the baseline while puncture and the systolic blood pressure of children received the palm operated game changed less than these did not received. Even though there were no significant differences, the experimental group still had smaller change than the control group.
In sum, palm operated games as the distraction intervention may stabilize pain physiological reaction when children underwent lumbar puncture. Thus, it is hoped that using appropriate palm operated games as distraction intervention while implementing frequent punctures may provide better supportive care for not only cancer children but also other pediatric patients to distract pain sensation.

第一章 緒論…………………………………………………………..01
第一節 研究動機及重要性………………………………………..01
第二節 研究目的…………………………………………………..05
第二章 文獻查證……………………………………………………..06
第一節 疼痛之概念………………………………………………...06
第二節 白血病患童的疼痛與相關緩解措施……………………...10
第三節 學齡患童穿刺的疼痛評估與生理反應…………………...14
第四節 影響白血病患童疼痛反應的相關因素…………………..21
第五節 轉移注意力減輕疼痛之成效與電動遊戲之運用…………..25
第三章 概念架構………………………………………………………29
第一節 概念架構……………………………………………………29
第二節 名詞界定……………………………………………………30
第三節 研究問題……………………………………………………31
第四節 研究假設……………………………………………………32
第四章 研究方法與過程………………………………………………33
第一節 研究對象與場所……………………………………………34
第二節 研究設計……………………………………………………35
第三節 研究工具……………………………………………………39
第四節 資料收集過程………………………………………………43
第五節 資料處理與分析方法………………………………………46
第六節 研究倫理的考量……………………………………………47
第五章 研究結果………………………………………………………48
第一節 研究對象之基本資料……………………………………48
第二節 白血病患童接受腰椎穿刺之疼痛生理反應…………….52
第三節 電動遊戲之成效…………………………………………61
第六章 討論……………………………………………………………69
第一節 白血病患童接受腰椎穿刺疼痛生理反應變化之分析…...69
第二節 電動遊戲之成效分析………………………………….73
第七章 結論與建議…………………………………………………..77
第一節 結論………………………………………………………..77
第二節 護理上之應用……………………………………………79
第三節 研究限制與建議………………………………………81
參考資料……………………………………………………………….84
表 目 錄 頁數
表5-1 研究對象的基本屬性………………………………………….51
表5-2 腰椎穿刺前後心跳速率之變化……………………………….55
表5-3 以GEE分析電動遊戲於心跳速率之變化………………......56
表5-4 腰椎穿刺前後收縮壓之變化………………………………..58
表5-5以GEE分析電動遊戲於收縮壓之變化……………….……59
表5-6 以GEE分析心跳速率之測量時間、時間與組別之交互作用.65
表5-7 以GEE分析收縮壓之測量時間、時間與組別之交互作用…67
圖 目 錄 頁數
圖3-1 電動遊戲對學齡白血病患童生理反應影響之概念架構圖…..29
圖4-1 研究設計圖……………………………………………………..37
圖4-2 資料收集流程圖………………………………………………..45
圖5-1 實驗組心跳速率（95%信賴區間）隨時間的變化…………..57
圖5-2 控制組心跳速率（95%信賴區間）隨時間的變化…………..57
圖5-3 實驗組收縮壓（95%信賴區間）隨時間的變化……………...60
圖5-4 控制組收縮壓（95%信賴區間）隨時間的變化…….………..60
圖5-5 每分鐘平均心跳速率之變化…………………………………..66
圖5-6 穿刺後每2分鐘平均收縮壓之變化…………………………..68

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