臺灣博碩士論文加值系統

肺癌為全球死因第六名，為台灣十大死因之首，手術是早期肺癌最佳治療方式，80%病患於手術後24小時內有中度到重度的疼痛經驗，40%出現焦慮症狀，導致自主神經產生變化。
本研究旨在探討引導式想像介入後對肺癌手術後病患疼痛、焦慮及心率變異度之成效，採類實驗研究設計，以宜蘭縣某醫院外科加護病房60位肺癌術後病患為對象，以隨機分配至實驗組及對照組各30位。在不影響術後之治療及護理，採彈性的介入時間，實驗組於術後1小時、術後3.5小時、術後16小時及術後23.5小時，各給予1次引導式想像錄音檔案20分鐘，而對照組為術後常規護理。於手術前一天進行焦慮及心律變異度之前測，入住加護病房意識清醒後予疼痛評估之前測，術後4小時進行中測及術後24小時進行後測，以疼痛數字等級量表(Numerical Rating Scale, NRS)、情境焦慮量表(State Trait Anxiety Inventory, STAI-S)評估疼痛及焦慮並以心率變異分析儀(Heart rate variability, HRV)分析心律間期標準差(standard deviation of all normal to normal intervals, SDNN)、高頻功率(high frequency power, HF)、低高頻功率比(low frequency power/high frequency ratio, LF/HF ratio)，評估自主神經生理變化。
研究結果以廣義估計方程式(Generalized estimating equation, GEE)進行統計分析，研究結果為實驗組於術後4小時之疼痛程度、焦慮程度、LF/HF Ratio皆比對照組低；術後24小時之疼痛程度、焦慮程度、LF/HF Ratio皆比對照組低，HF比對照組高，均達顯著差異(p<0.001)。
引導式想像為簡單不具侵入性之護理措施，不僅可減少肺癌手術後病患之疼痛及焦慮，亦可提升副交感神經活性，改善交感與副交感神經的平衡，此研究結果可作為手術後減輕疼痛及焦慮之護理措施。

Lung cancer ranks 6th among the global causes of death, while ranks first in Taiwan. Surgery is the best treatment for early-stage lung cancer. 80% of patients experience moderate to severe pain within 24 hours after surgery, and 40% of patients show the anxiety symptom, leading to autonomic nervous system changes.
The purpose of this study is to explore the effect of guided imagery for pain, anxiety, and heart rate variability on postoperative lung cancer patients. The quasi-experimental research design was adopted, with 60 postoperative lung cancer patients from the surgical intensive care unit of a hospital in Yilan County as research participants. Through random distribution, 30 patients each were distributed to the experimental group and the control group. Provided that patient treatment was not affected and no additional workload was imposed on the nursing personnel, flexible intervention time was adopted. For the experimental group, a 20 minute audio guided imagery was administered an hour, 3.5 hours, 16 hours, and 23.5 hours after surgery respectively; for the control group, postoperative routine nursing care was administered. An anxiety and heart rate variability pretest was carried out one day before surgery; a pain assessment pretest was carried out after admission into the intensive care unit and being conscious; an intermediate test was carried out 4 hours after surgery; and a posttest was carried out 24 hours after surgery. The Numerical Rating Scale, NRS for pain and the State Trait Anxiety Inventory, STAI-S were used for evaluating pain and anxiety; the Heart Rate Variability, HRV was used to analyze standard deviation of all normal to normal intervals, SDNN; high frequency power, HF; and low frequency power/high frequency ratio, LF/HF ratio, to evaluate the physiological changes of the autonomic nervous system.

The results were using Generalized Estimating Equation, GEE for statistical analysis. The research results show that for the experimental group, the degree of pain, the degree of anxiety, and the LF/HF Ratio 4 hours after surgery were all lower compared to that of the control group; the degree of pain, the degree of anxiety, and the LF/HF Ratio 24 hours after surgery were also lower compared to that of the control group; the HF was higher than that of the control group, all reaching significant differences (p<0.001).
The guided imagery is a simple and non-invasive nursing care measure that not only reduces the pain and anxiety of postoperative lung cancer patients, but also enhances the activity of the parasympathetic nerves and improves the balance between sympathetic and parasympathetic nerves. The research results shall serve as postoperative nursing care measures for alleviating pain and anxiety.

中文摘要-----------------------------------------------------------------i
英文摘要-----------------------------------------------------------------ii
目次---------------------------------------------------------------------iv
表次---------------------------------------------------------------------ⅵ
圖次---------------------------------------------------------------------ⅶ

第壹章 緒論
第一節 研究背景與動機----------------------------------------------------1
第二節 研究目的----------------------------------------------------------3
第三節 研究問題----------------------------------------------------------3
第四節 研究假設----------------------------------------------------------3
第五節 名詞界定----------------------------------------------------------4
第六節 研究架構----------------------------------------------------------6

第貳章 文獻探討
第一節 肺癌手術病患疼痛與焦慮--------------------------------------------7
第二節 疼痛及焦慮與心率變異度相關研究-------------------------------------11
第三節 引導式想像介紹與疼痛與焦慮相關研究---------------------------------14
第四節 引導式想像與心率變異度相關研究-------------------------------------17

第叁章 研究方法
第一節 研究設計---------------------------------------------------------18
第二節 研究對象及樣本計數------------------------------------------------20
第三節 研究工具與測量方法------------------------------------------------21
第四節 介入措施---------------------------------------------------------24
第五節 研究倫理考量-----------------------------------------------------26
第六節 資料處理及分析---------------------------------------------------27

第肆章 研究結果
第一節 研究對象人口學之基本屬性-----------------------------------------28
第二節 引導式想像對於肺癌術後病患疼痛之影響------------------------------30
第三節 引導式想像對於肺癌術後病患焦慮之影響------------------------------32
第四節 引導式想像對於肺癌術後病患心率變異度之影響------------------------34

第伍章 討論
第一節 引導式想像對於肺癌手術後病患疼痛之影響----------------------------39
第二節 引導式想像對於肺癌手術後病患焦慮之影響----------------------------40
第三節 引導式想像對於肺癌手術後病患心率變異度成效之影響-------------------41

第陸章 結論與建議
第一節 結論------------------------------------------------------------43
第二節 研究限制--------------------------------------------------------44
第三節 建議------------------------------------------------------------45

參考文獻
中文部分-----------------------------------------------------------------46
外文部分-----------------------------------------------------------------48

附錄
附錄一 引導式想像教案---------------------------------------------------57
附錄二 引導式想像對疼痛與焦慮的相關研究文獻整理---------------------------61
附錄三 國立陽明大學附設醫院人體試驗委員會研究證明書-----------------------64
附錄四 國立陽明大學附設醫院人體試驗委員會研究計畫結案證明-----------------65
附錄五 中文版情境、特質焦慮量表之授權書----------------------------------66


表 次
表3-1研究設計模式-------------------------------------------------------19
表4-1研究對象人口學基本屬性統計分析--------------------------------------29
表4-2引導式想像介入前中後對肺癌術後病患NRS量表之 t 檢定-------------------30
表4-3 GEE分析引導式想像介入前中後對肺癌術後病患疼痛之影響-----------------31
表4-4引導式想像介入前中後對肺癌術後病人STAI-S量表之 t 檢定----------------32
表4-5 GEE分析引導式想像介入後對肺癌術後病人焦慮之影響---------------------33
表4-6 引導式想像介入前中後心率變異度之 t 檢定----------------------------35
表4-7 GEE分析引導式想像介入後對肺癌術後病人心率變異度之影響---------------38

圖 次
圖3-1收案流程圖--------------------------------------------------------25
圖4-1引導式想像介入前中後對肺癌手術後病人NRS量表平均值折線圖--------------30
圖4-2引導式想像介入前中後對肺癌手術後病人STAI-S 量表平均值折線圖----------32
圖4-3引導式想像介入前中後對肺癌手術後病人SDNN 平均值折線圖----------------36
圖4-4引導式想像介入前中後對肺癌手術後病人HF 平均值折線圖------------------36
圖4-5引導式想像介入前中後對肺癌手術後病人LH/HF ratio 平均值折線圖---------36

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